Our Position
The Care Alliance position regarding the legalisation of euthanasia and assisted suicide, agreed by all its member organisations (who include all of the major providers of palliative care in New Zealand), is that they are unnecessary, unsafe and unwise.
Euthanasia: Unnecessary, Unsafe, Unwise
Unnecessary
ANZSPM note that “much of the community debate currently fuelling discussion about alternative choices, including assisted dying, highlight inadequacies in the current system. Legislating for assisted dying in this context presents a risk that decisions will be made by persons who have not been given optimum choices for their end of life care.” The focus needs to be on improving the delivery of, and equity of access to, high quality end of life care in New Zealand.
There are other and better means by which the intention of this Bill – namely the prevention of needless suffering – can be realised without resorting to the administration of lethal medications to deliberately and immediately end the life of any patient.
High quality Palliative Care exists to improve the quality of care of patients with life-limiting illnesses and their families. It encompasses not only the physical but also the emotional, social, spiritual and cultural needs of the individual and their family unit.
A Dutch study looking at the impact of euthanasia on Primary Care Practitioners concludes that GP’s willing to perform euthanasia often feel forced by patients to offer euthanasia because of the hopeless circumstances in which patients find themselves. The lack of choices re care is a reason to improve access to high quality end-of-life care in New Zealand, not a reason to legalise euthanasia.
Expert evidence from those in favour of legalising euthanasia and those opposed is clear that, in the worst-case scenario, palliative sedation (which is temporary and fully reversible) is available to address intractable physical pain.
Our current laws which provide essential protection for all citizens and residents of New Zealand are not broken.
Unsafe
The fundamental danger of legalising euthanasia and assisted suicide, which is the essential purpose of the End of Life Choice Bill, is that we would cross a ‘Rubicon’ – a line of no-return – by allowing the State to determine, in certain circumstances, that a particular life is not worth living and should therefore be terminated.
Any euthanasia regime creates different classes of citizens – those whose lives are worthy of living and those whose lives don’t warrant the same protections offered by the State in favour of life that, to date, all citizens enjoy.
Assisted dying legislation poses the risk of wrongful deaths as the result of inherent uncertainties of medical diagnosis, prognostication, and determination of mental capacity.
There is a real and substantial risk that persons will be coerced, both subtly and overtly, into ending their lives prematurely. The wording in the End of Life Choice bill that the attending medical practitioner should “do his or her best to ensure that the person expresses his or her wish free from pressure from any other person” suggests an acceptance by the drafters of the legislation that it is impossible to exclude coercion as a factor in all circumstances.
In jurisdictions overseas where euthanasia has been enacted, including Belgium and the Netherlands, there is a continuing and exponential growth in the numbers of people accessing a premature death which indicates that the practice is shifting from an act of last resort for terminal illness to becoming the default way to die. In certain Dutch cities, euthanasia now accounts for up to 15% of deaths.
Overseas, the reasons for wanting euthanasia continue to expand. Conditions include: early dementia, accumulating age related complaints, psychiatry, and other cases such as blindness, autism, and grief. In the Netherlands “Hundreds of patients yearly receive euthanasia who could have lived for years or decades.”
While it is argued by some that providing people with euthanasia will prevent violent suicides, there is no evidence to support this. While it could be true for some, rates of suicide in the Netherlands have risen by 40% in the period 2007 – 2016 despite the wide availability and acceptability of euthanasia.
Euthanasia poses significant risks for vulnerable people, not simply in the sense that people might be forced externally, but because such a law creates an expectation that this is the right thing to do – the right to choose will become a ‘duty to die’ and it creates an additional burden on those who do not want to avail themselves of a premature death because they will need to ‘justify’ their decision not to die and will be increasingly perceived as swallowing up increasingly scarce resources.
Unwise
Much of the community debate currently fuelling discussion about alternative choices, including assisted dying, highlight inadequacies in the current healthcare system, including inequitable access to high quality palliative care. Legislating for assisted dying in this context presents a risk that decisions will be made by persons who have not been given optimum choices for their end of life care.
Physician assisted suicide and euthanasia are unethical and contrary to the fundamental tenets of medical practice and are not in the interests of patient-centred care.
Under the proposed End of Life Choice Bill, a patient could potentially bypass palliative care or psychiatric care for a treatable condition to alleviate their symptoms. As a result, “assisted dying” becomes an alternative option to available and appropriate treatments.
Legalising physician-assisted suicide or euthanasia under any conditions may compromise the effective delivery of Palliative Care and places at risk the frailest and most vulnerable patients the medical profession has the privilege to care for.
New Zealand has an acknowledged mental health crisis. Under the End of Life Choice Bill, a young person with depression could qualify for euthanasia. We need to work in the opposite direction – to make any kind of suicide unnecessary.
The rising rates of suicide in countries such as the Netherlands in the face of widespread availability of euthanasia points to a ‘cultural shift’ in which death is increasingly seen as an acceptable solution to any form of suffering.