Who is eligible?
The person who is eligible for assisted dying 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—
(i) a terminal illness that is likely to end his or her life within 6 months; or
(ii) a grievous and irremediable medical condition; and
(d) is in an advanced state of irreversible decline in capability; and
(e) experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable; and
(f) has the ability to understand—
(i) the nature of assisted dying; and
(ii) the consequences for him or her of assisted dying.
- An eligible person must be aged 18 years and over, but this age limit is arbitrary.
In Canada the age limit for MAID (Medical Assistance in Dying) is already being challenged on the grounds that it discriminates against children: “children also experience ‘grievous and irremediable medical conditions’ that cause them intolerable pain and suffering. As it stands, the arbitrary age cut-off prohibits some people from considering the option to face their suffering in a way that is right for them. This has the potential to be discriminatory and unjust.”
In New Zealand, the Code of Health and Disability Services Consumers’ Rights does not fix a particular age for consent to or refusal of health treatment; children, like other health consumers, are presumed ‘competent’, unless it is otherwise established. The age limit of 18 years is likely to be challenged in New Zealand.
- ‘Terminal illness that is likely to end his or her life within 6 months’
Prognosis – predicting when someone is likely to die – is highly inaccurate. One study has found that only 20% of (468) predictions of survival time for patients who were referred to Hospice were accurate (within 33% of actual survival).
In Oregon, which also requires ‘reasonable medical judgment’ of death within 6 months, the duration between first request and death in 2017 ranged from 15 to 603 days; that is, at least one person lived for almost a year and eight months after requesting assisted suicide. Over the period from 1998-2016, the duration between first request and death ranged from 14 to 1009 days, so at least one person survived for 2 years and 9 months after requesting assisted suicide. An accurate prognosis of length of life is clearly problematic.
- ‘a grievous and irremediable medical condition’ … is in an advanced state of irreversible decline in capability … experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable’
These descriptions are subjective and can be interpreted widely to include a range of illnesses or disabilities, even such things as rheumatoid arthritis or diabetes, as well as mental health issues, such as depression.
The criterion ‘grievous and irremediable medical condition’ requires doctors to make a judgement about a patient’s condition when even with the best of intentions and the availability of diagnostic technology, diagnosis is often inaccurate. Autopsy studies identify major diagnostic discrepancies in 10-20% of cases. A review of studies that investigated potentially lethal diagnostic errors in Intensive Care Units, found that 28% of autopsied ICU patients had at least one misdiagnosis.
The bill specifies ‘unbearable suffering that cannot be relieved in a manner that he or she [the person who requests assisted dying] considers tolerable’. That is, it might be the doctor’s clinical assessment that a therapy is appropriate and effective, but this is insufficient to allow the doctor to reject a request for assistance to die.
Christakis, N A and E B Lamont. “Extent and determinants of error in physicians’ prognoses in terminally ill patients: prospective cohort study” Western journal of medicine vol. 172,5 (2000): 310-3.
Oregon Death With Dignity Act 2017 Data Summary. Oregon Health Authority, Public Health Division. http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year20.pdf
Winters, B., Custer, J., Galvagno, S. M., Colantuoni, E., Kapoor, S. G., Lee, H., … & Newman-Toker, D. (2012). Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf, 21(11), 894-902.
Timeline of the Bill
Introduced in June 2016, and passing it’s first reading in December 2017, the Bill was referred to the Justice Select Committee who then called for public submissions. These closed 6 March 2018, and the process of hearing the oral submissions was undertaken throughout the year.