20 Reasons To Vote NO

A person may refuse medical treatment, even if it will result in his or her death.^[5] Section 11 of the New Zealand Bill of Rights Act 1990 says, “Everyone has the right to refuse to undergo any medical treatment.” This can include ‘Do Not Resuscitate’ orders. Refusing medical treatment is not euthanasia. The Australian and New Zealand Society of Palliative Medicine (ANZSPM 2013) states:

“Patients have the right to refuse life sustaining treatments including the provision of medically assisted nutrition and/or hydration. Refusing such treatment does not constitute euthanasia.”

It’s really important to understand the terminology in this debate. Most people simply want to ensure that the administration of pain relief and the withdrawal of burdensome treatment are not treated as illegal. That’s already the case. There is no legal or ethical requirement that a diseased or injured person must be kept alive ‘at all costs’. The law has drawn a clear and consistent line between withdrawing medical support thereby allowing the patient to die of his or her own medical condition, versus intentionally bringing about the patient’s death.

Voluntary Euthanasia is the act of intentionally, knowingly, and directly causing the death of a patient, at the request of the patient. If someone other than the person who dies performs the last act, euthanasia has occurred.^[1] Involuntary Euthanasia is where the person is able to give consent but has not done so, or where a person was euthanised against their will. Non-voluntary Euthanasia is where the person lacks capacity to give consent or request to end his or her life.[2]

Assisted Suicide is the act of intentionally and knowingly providing the means of death to another person at that person’s request in order to facilitate his/her suicide. If the person who dies performs the fatal act, assisted suicide has occurred.^[3]

Physician (doctor)–assisted suicide is where the person providing the means (e.g. lethal drugs) is a medical practitioner.

Assisted dying is a term that is also used for both euthanasia and assisted suicide.

NOTE:
The End of Life Choice Act 2019 allows both euthanasia and assisted suicide. It would allow doctors and nurse practitioners to provide or administer a lethal dose of drugs.

In contrast, Palliative care is

“active total care… for people whose illness is no longer curable, the goal is around providing quality of life, managing pain and symptoms to enable people to live every moment in whatever way is important to them.” (Hospice NZ)

What is not euthanasia

The administration of pain relief

Everyone has a right to effective pain relief. The administration of drugs in doses sufficient to alleviate pain and suffering rarely causes death. It is permitted, and it is ethical. From time to time, a patient may die while receiving such drugs. That is not euthanasia, since the death of the patient was not the intended outcome of the medication. The Australian and New Zealand Society of Palliative Medicine (ANZSPM 2013) states: “Treatment that is appropriately titrated to relieve symptoms and has a secondary and unintended consequence of hastening death, is not euthanasia.” (our emphasis added) (“Titrated” means measured and adjusted).

The withdrawal of burdensome and futile life-prolonging treatment

The common practice of withdrawing futile medical assistance from a patient for whom it is not accomplishing anything useful, despite this action being associated potentially with the person’s death, is lawful. There is no legal or ethical requirement that a diseased or injured person must be kept alive ‘at all costs’. The law has drawn a clear and consistent line between withdrawing medical support, thereby allowing the patient to die of his or her own medical condition, and intentionally bringing about the patient’s death by a positive act.^[4]

What does the law currently say about suicide

Section 179 of the Crimes Act 1961 (NZ) states that “Everyone is liable to imprisonment for a term not exceeding 14 years who—(a) incites, counsels, or procures any person to commit suicide, if that person commits or attempts to commit suicide in consequence thereof; or (b) aids or abets any person in the commission of suicide.” Furthermore, under s 151 there is a duty to provide the “necessaries” of life to those who have the care or charge of a “vulnerable adult” who is unable to provide himself or herself with these essentials.

Diagnosis and prognosis are based on probability, not certainty. Some people will be euthanised on account of a disease they thought they had but did not. The Act that we are voting on relies on a diagnosis that a person suffers from a terminal illness which is “likely” to end his or her life within six months. There are many examples of individuals who have outlived their prognoses – sometimes by months, even years. A diverse range of research into this issue over the past several decades suggests that the diagnosis is wrong 10–15% of the time.[8] A 2012 paper published in the British Medical Journal noted that 28% of autopsies report at least one misdiagnosis[9]. A study of doctors’ prognoses (the medical prediction of the course of a disease over time) for terminally Ill patients found only 20% of predictions were within 33% of the actual survival time[10].

Victoria Reggie Kennedy, widow of the late Democratic Senator Edward Kennedy, campaigned against a bill that would have legalised physician-assisted suicide in Massachusetts. She said:

“When my husband was first diagnosed with cancer, he was told that he had only two to four months to live, that he’d never go back to the U.S. Senate, that he should get his affairs in order, kiss his wife, love his family and get ready to die. But that prognosis was wrong. Teddy lived 15 more productive months.… Because that first dire prediction of life expectancy was wrong, I have 15 months of cherished memories – memories of family dinners and songfests with our children and grandchildren; memories of laughter and, yes, tears; memories of life that neither I nor my husband would have traded for anything in the world. When the end finally did come – natural death with dignity – my husband was home, attended by his doctor, surrounded by family and our priest.”[11]

Coercion is subtle. The reality is that terminally ill people are vulnerable to direct and indirect pressure from family, caregivers, and medical professionals, as well as self-imposed pressure. They may come to feel euthanasia would be ‘the right thing to do’; they’ve ‘had a good innings’ and do not want to be a ‘burden’ to their nearest and dearest. Talk to any doctor and they will tell you it is virtually impossible to detect subtle emotional coercion, let alone overt coercion, at the best of times.

Annual reports by Oregon Public Health contain data on the numbers of patients who reported that part of their motivation to request euthanasia was because they felt themselves to be a “burden on family and friends”.[16] 49 percent of patients who requested assisted suicide in 2016 did so out of concern for being a burden on their family; only 13% did so in 1998.

As 21 mental health practitioners and academics recently argued, there is mounting statistical evidence from Oregon, Belgium and the Netherlands that as the numbers using assisted dying rise, so too do suicide rates in the general population. It may be that promoting suicide as a response to suffering is a message that cannot be contained to just those with a terminal illness. Proponents of the Act that we are voting on have been asked to prove that legalising assisted suicide won’t raise the general suicide rate, but they won’t because they can’t. On the one hand society will offer some individuals assistance to commit suicide, i.e. euthanasia,  yet on the other hand seek to prevent individual suicides. Given our suicide epidemic, sensible and caring thinking says it is too risky to proceed.

Research on human decision-making suggests that when a person is suffering, decision-making becomes less rational.^[18] Most of the demands for legalising euthanasia and assisted suicide come from strong-minded individuals who are intelligent, articulate and who clearly comprehend their predicament. But many people are not like that. Yet a euthanasia law will have to protect everyone – the inarticulate as well as the articulate, the impaired, gullible or naïve, as well as the intelligent and alert.^[19]

The recent government report on euthanasia (2017) said:

“Many submitters were concerned that if assisted dying was legalized, people would see death as an acceptable response to suffering. It would be difficult to say that some situations warranted ending one’s life while others do not. These submitters were concerned that while terminal illnesses would initially be the only scenario in which ending one’s life would be considered acceptable, this would quickly widen to include any degree of physical pain, then to include mental pain, and then in response to many other situations that arise throughout life… Several submitters suggested that, during their worst periods of depression, they would have opted for euthanasia had it been available in New Zealand.”

Advocates of assisted suicide tried to suggest that suicide can be categorised as either ‘rational’ or ‘irrational’. But the government report also said:

“This distinction was not supported by any submitters working in the field of suicide prevention or grief counselling. On the contrary, we heard from youth counsellors and youth suicide prevention organisations that suicide is always undertaken in response to some form of suffering, whether that is physical, emotional, or mental.”

Advocates for the rights of people with disabilities are correct to be concerned. New Zealander Dr John Fox, a sufferer of spastic hemiplegia who is in daily pain, says:

“Don’t drop us. Don’t make it harder for us. Don’t tempt us to end our lives. When we have our darkest moments, we need our country to reflect back to us that we are loved, necessary, valued and equal. Even though they say they’ve fixed [the Act], we know that a law like this broadens, that we can’t control it, that loopholes come back to haunt us. That’s why [David] Seymour’s Bill is dangerous.”

As disability rights group Not Dead Yet put it, “There are endless ways of telling disabled people time and time again that their life has no value.”[23]

The vast majority of euthanasia/assisted suicide deaths are made on the basis of disability, not because a person is in pain. This is backed by the Oregon statistics that show 90% say they requested assisted suicide because they were “less able to engage in activities making life enjoyable” and 87% said they were requesting because they were “losing autonomy” – compared to 33% who indicated that they were requesting to die because of pain or concern about pain.

Baroness Campbell of Surbiton, former Commissioner of the Equality and Human Rights Commission and of the Disability Rights Commission, who has spinal muscular dystrophy has argued in the UK House of Lords: “…The Bill offers no comfort to me. It frightens me because, in periods of greatest difficulty, I know that I might be tempted to use it. It only adds to the burdens and challenges which life holds for me”.[24]

There are many examples.[25] In December 2012, Marc and Eddy Verbessem, 45-year-old deaf twins, were eutha­nised in a Belgian hospital after they discovered they were going blind.[26] Nancy Verhelst, a 44-year-old transsexual Belgian whose doctors made mistakes in three sex change operations, was left feeling as though she was a “monster.” She then requested—and was granted—euthanasia by lethal injection.[27] In the Netherlands, the euthanized include Ann G., a 44-year-old woman whose only ailment was chron­ic anorexia.[28] In the beginning of 2013, Dutch doctors administered a lethal injection to a 70-year-old blind woman because she said the loss of sight constitut­ed “unbearable suffering.”[29] In early 2015, a 47-year-old divorced mother of two suffering from tinnitus, a loud ringing in the ears, was granted physician-assisted suicide in the Netherlands.[30] She left behind a 13-year-old son and a 15-year-old daughter. Gerty Casteelen was a 54-year-old psychiatric patient with molysomophobia, a fear of dirt or contamination. Her doctors decided that she would not be able to control her fear and agreed to administer a lethal injection.[31]

Opposition to the Act that we are voting on has come from those in the disability sector, senior citizens, human rights advocates, lawyers, doctors and others in the health sector.

Source: Care Alliance analysis

No independent witnesses are required at any stage of the process, including at the death [s 16]. In contrast, two people need to witness the signing of the written request in Oregon, one of whom must be totally independent (not a relative or someone able to benefit from the estate, or an employee of a health care facility or the attending medical practitioner) [s 2.02]. Canada*[s 241.2 (3)(c)] and Victoria (Aus) [s 34] require two independent witnesses as well as the co-ordinating medical practitioner.
[The majority of MPs voted against requiring an independent witness at the death – SOP 211].

There is no mandatory cooling-off period before the administration of the lethal dose, such as the minimum of 15 days in Oregon [s 3.06][42] (with a recently introduced limited exception), 9 days in Victoria [s 38][43] or 10 days in Canada* [s 241.2(3)(g)]. The only timeframe specified in the End of Life Choice Act 2019 is a minimum of 48 hours between the writing of the prescription and the chosen time of death [s 15(4)], which is also a requirement in Oregon [s 3.08]. That means the whole process from request to death could be completed in just a few days.
[The majority of MPs voted against a one-week cooling-off period – SOP 308 ].

There is no requirement that a person tries palliative care or other treatments first. That means that for some people, euthanasia will not be a last resort. [s 8]
[The majority of MPs voted against putting appropriate safeguards in this area – SOP 286, SOP 300].

Supporters of the proposed law claim that it doesn’t threaten people with disabilities. However, many disabilities are life-limiting and involve complications that can become life-threatening. Some chronic conditions can become terminal if the person is refusing treatment [44]. In Oregon “death within six months” has been interpreted by the health authorities to include “death within six months if not receiving medical treatment”.
[An appropriate safeguard was proposed, but MPs didn’t even debate or vote on it – SOP 280].