Understanding the End of Life choice act 2019
The End of Life Choice Bill was passed in Parliament in November 2019, and then became the End of Life Choice Act 2019. It seeks to make euthanasia and assisted suicide legal in New Zealand.
The Act will only come into force if a majority of electors voting in the upcoming referendum agree to support it. If a majority vote against it, then assisted suicide and euthanasia will remain illegal in New Zealand.
One of the things that has become apparent in polling on this issue is the degree of confusion around what the End of Life Choice Act 2019 does and doesn’t allow.
- Turning off life support is already legal.
- ‘Do not resuscitate’ orders, where patients can request in advance not to be resuscitated if this becomes necessary to keep them alive, are already legal.
- Refusing treatment is already legal.
- Administering high doses of medication with the express purpose of relieving pain and other symptoms is already legal.
A central principle of palliative or end-of-life care is that it does not prolong, and it does not hasten, death. Currently, New Zealand patients at the end of their lives have many choices around their treatment at different stages of their illness.
The End of Life Choice Act 2019 introduces something very different, and unprecedented in New Zealand law. It allows doctors to kill their patients, under certain circumstances. Though doctors currently have many options of care in responding to the illnesses of their patients, deliberately bringing about death is not and has never been one of those options in New Zealand.
The Care Alliance believes that offering the option of death as an aspect of medical care is a fundamentally flawed approach to the practice of medicine, and will have serious and far-reaching implications across society.
Here are a few key definitions to help you understand the terms in the Act. Note that the End of Life Choice Act would legalise both euthanasia and assisted suicide.
A deliberate act to end the life of a patient who is suffering with a serious illness.
When lethal drugs are prescribed or supplied by to a person at their request and self-administered by the patient with the aim of ending his or her life.
A term that is used broadly to cover both euthanasia and assisted suicide.
Assisted dying is a controversial term because it fails to differentiate acts of ‘assisted suicide’ from acts of ‘euthanasia’, a difference that has significant legal, political, ethical, practical and social implications.
It also fails to adequately distinguish between ethically acceptable acts such as withdrawing or withholding treatment (when it is no longer medically indicated) and the intentional ending of a person’s life.
Palliative care is for people whose illness is no longer curable. It focuses on providing quality of life by managing pain, symptoms, and other forms of suffering to enable people to live well within the time they have available. It is holistic, involving the physical, spiritual, cultural, emotional and social well-being of a person living with a life-limiting condition.
A term used to describe acts of euthanasia and assisted suicide that actively involve the intervention of one or more health professionals.
The World Medical Association was formed in 1947. Given the horrors of the Second World War in general, and the Holocaust in particular, medical ethics have been a central concern from its inception.
The WMA’s resolution on euthanasia is:
Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002 and reaffirmed with minor revision by the 194th WMA Council Session, Bali, Indonesia, April 2013
The World Medical Association’s Declaration on Euthanasia, adopted by the 38th World Medical Assembly, Madrid, Spain, October 1987 and reaffirmed by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 states:
“Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.”
The WMA Statement on Physician-Assisted Suicide, adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 likewise states:
“Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.”
The World Medical Association has noted that the practice of active euthanasia with physician assistance, has been adopted into law in some countries.
BE IT RESOLVED that:
The World Medical Association reaffirms its strong belief that euthanasia is in conflict with basic ethical principles of medical practice, and
The World Medical Association strongly encourages all National Medical Associations and physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions.
The NZMA was founded in 1886 to represent doctors practising in New Zealand. It is a member of the World Medical Association.
The NZMA’s position statement on euthanasia and doctor assisted suicide, adopted in 2005, is:
The NZMA is opposed to both the concept and practice of euthanasia and doctor assisted suicide.
Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s request or at the request of close relatives, is unethical.
Doctor-assisted suicide, like euthanasia, is unethical.
The NZMA however encourages the concept of death with dignity and comfort, and strongly supports the right of patients to decline treatment, or to request pain relief, and supports the right of access to appropriate palliative care.
In supporting patients’ right to request pain relief, the NZMA accepts that the proper provision of such relief, even when it may hasten the death of the patient, is not unethical.
This NZMA position is not dependent on euthanasia and doctor-assisted suicide remaining unlawful. Even if they were to become legal, or decriminalised, the NZMA would continue to regard them as unethical.
ANZSPM represents doctors involved in palliative care.
Its position statement on the practice of euthanasia and assisted suicide was adopted in 2013:
The Palliative Medicine discipline does not include the practice of euthanasia or assisted suicide. ANZSPM activities are limited to the Palliative Medicine discipline. There is a clear distinction between good care for the dying and active interventions instituted in order to deliberately end the life of a patient.
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.
Good medical practice mandates that the ethical principles of beneficence and non- maleficence should be followed at all times. The benefits and harms of any treatments (including the provision of medically assisted nutrition and/or hydration) should be considered before instituting such treatments. The benefits and harms of continuing treatments previously commenced should be regularly reviewed. Withholding or withdrawing treatments that are not benefitting the patient, is not euthanasia.
Treatment that is appropriately titrated to relieve symptoms and has a secondary and unintended consequence of hastening death, is not euthanasia.
Palliative sedation for the management of refractory symptoms is not euthanasia.
Requests for euthanasia or assisted suicide should be acknowledged with respect and be extensively explored in order to understand, appropriately address and if possible remedy the underlying difficulties that gave rise to the request. Appropriate ongoing care consistent with the goals of Palliative Medicine should continue to be offered.
When requests for euthanasia or assisted suicide arise, particular attention should be given to gaining good symptom control, especially of those symptoms that research has highlighted may commonly be associated with a serious and sustained “desire for death” (e.g. depressive disorders and poorly controlled pain). In such situations early referral to an appropriate specialist should be considered.
Despite the best that Palliative Care can offer to support patients in their suffering, appropriate specialist Palliative Care to remedy physical, psychological and spiritual difficulties may not relieve all suffering at all times.
ANZSPM acknowledges the significant deficits in the provision of palliative care in Australia and New Zealand, especially for patients with non-malignant life limiting illnesses, those who live in rural and remote areas, residents of Residential Aged Care Facilities, the indigenous populations and those from culturally and linguistically diverse backgrounds.
ANZSPM advocates for health reform programs in Australia and New Zealand to strengthen end of life care by remedying shortages in the palliative care workforce (including in the specialist medical, nursing, and allied health fields), ensuring improved access to appropriate facilities and emphasising the role of advance care plans and directives.
ANZSPM advocates for increased carer support for respite care to decrease the sense of burden for many patients at the end of life.