Disability, Mental Illness, and the EOLC Act


Why are we worried about disability and mental illness, when you can’t access euthanasia and assisted suicide just because you are disabled or have a mental illness?

Let’s unpack this.

The History

In the first draft of the End of Life Choice Bill, the eligibility criteria included people with “grievous and irremediable conditions” who were in “an advanced state of irreversible decline in capability.” This version clearly allowed people with a mental illness or disability – people who were otherwise not terminally ill –  to have assisted dying where the main or sole reason was their mental illness or disability. This clause was removed before the 2nd Reading

The Misunderstanding

Because the phrase “grievous and irremediable conditions” has been removed, many people now incorrectly believe that persons suffering from any form of mental disorder or illness, or with a disability of any kind, are not eligible for assisted dying.

This is not true. 

What the Act Says Now

What the law says is that people are not eligible by reason only that they have a mental disorder or illness or disability. But people can have a terminal illness, which makes them eligible for assisted dying, and have a disability or mental illness. In other words, there will be people with a terminal illness, who are over 18, and who are likely to have less than 6 months to live, who also have a mental disorder or disability. These people are perfectly eligible for the Act so long as they meet the competency requirements (see our page about Unpacking the End of Life Choice Act 2019). 

The Risks

People with a terminal illness and a mental illness or disability are potentially more vulnerable than others to the suggestion that they would be ‘better off dead’. Why? Because we live in a society which is ‘able-ist’ –  society which focuses on people who are perceived to be independent and living active lives, excluding those who don’t appear to meet these ideals. People who do not have that privilege are more likely to question the value of their own lives, as they continually encounter ableist attitudes that create physical and psychological barriers to their full inclusion in society. Because of this, it is not unreasonable to suggest that persons with a disability or with severe mental illness, who otherwise fit the eligibility criteria, might be more likely to choose assisted suicide or euthanasia than others without these added challenges. 

The Act does nothing to address these …..

Legalised Discrimination

As the Care Alliance wrote in its submission to the Justice Select committee: “It is an essential underpinning of any euthanasia/assisted suicide regime that it 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. The fundamental danger of legalising euthanasia and assisted suicide, which is the essential purpose of this Bill, is that we would have crossed 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.”

In other words any assisted death regime amounts to a form of ‘legalised discrimination’, because it requires that we make a judgement about a person’s worth, and therefore their right to life, by assigning them to one group or the other. In our current culture, the rationale for such discrimination draws, largely sub-consciously, from a deep well of discriminatory ageist and ableist thinking. This was made clear from comments made by MP Louisa Wall in the recent parliamentary debate when she stated that not being able to care for oneself, not being able to go to the toilet, and needing to be looked after were “degrading” and amounted to a loss of respect and dignity that was sufficient to justify being dead. These are conditions that many disabled people live with daily, and in no way does it lessen their dignity as people. Attitudes such as Louisa Wall’s –  and they are commonplace –  illustrate clearly why aspects of the eligibility criteria for assisted death also function as discrimination against the disabled. 

It is for these reasons that –  almost without exception – disability advocacy organisations world-wide oppose assisted dying. 

Overseas Widening of the Criteria

It is also worth reflecting on the fact that in the Netherlands and in Belgium, it was not originally envisaged that disabled people or mentally ill people would be eligible. However, that has changed. In Quebec, the legal phrase, “a reasonably foreseeable natural death”, originally seen to be an important safeguard, has also been removed because it was seen as discriminatory. In addition, there is now considerable pressure in Canada to include unbearable suffering from mental illness as a criterion for assisted dying, and it seems highly likely that this change will also happen.  

New Zealand’s Likely Future

If the End of Life Choice Act 2019 becomes law, we should expect that it will only be a matter of time before the exclusion of unbearable suffering – whether related to disability or mental illness – will be challenged and removed in New Zealand, as has happened overseas.