Free Thoughts - End of life choice

ACT Leader David Seymour

The contentious issue of voluntary euthanasia is one I have been considering for some time, and I want to explain here why I am preparing a private member’s (End of Life Choice) Bill to lodge for ballot in Parliament.

The primary motivation for this Bill is compassion.

Many of my constituents have urged me to proceed with a Bill, particularly in light of the withdrawal last year of a similar Bill sponsored by Iain Lees-Galloway, originally introduced by former MP Maryan Street. Two previous Bills on this issue have in the past failed to gain Parliamentary support, but the clear international trend since the 1990s is towards the legalisation of medically assisted end of life choice.

The motivation for this Bill is the very real anguish faced by people with terminal illness, as they anticipate the prospect of intolerable suffering, and the indignity of the final few days and weeks of their lives. While pain can be ameliorated somewhat, the suffering and indignity of that final period of life remains a profound concern to many people.

The intention of the Bill is to allow people with a “grievous and irremediable medical condition” to obtain medical aid to die if they should so choose.

I appreciate that within our community there is a wide range of religious and philosophical views which influence attitudes to this issue. What is unthinkable for some, is considered by others the most compassionate way to address the inevitability of end of life, and the realities of terminal illness.

The Bill I intend to lodge will offer choice that is currently prohibited, for those in our community who are grievously and irremediably ill and who wish to have the option, as they near life’s end, to choose the manner and timing of their final days.

The protections designed to avoid potential abuse are crucial, and would need to be fully examined before any final Bill was to return to the House. A Select Committee process considering specific proposals will enable all these matters to be considered in detail and in public, will provide an opportunity for the full range of views in our community to be heard, and will allow us to examine the international experience.

There are several key considerations behind my intention to lodge a private members Bill.

In my view it is politically, morally, legally and, in terms of public policy, the right thing to do.

I will consider each of these in turn.

Legally this is the right thing to do.

As noted in the recent judgement on the Lecretia Seales case, the issue of end of life choice is a matter for Parliament to determine.

Likewise, earlier this year the Canadian Supreme Court determined unanimously that "The prohibition on physician-assisted dying infringes on the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice."

But the Court suspended its judgement for 12 months, giving the Canadian Parliament a year to draft new legislation to reflect that judgement.

This reflected a view that it is a matter for Parliament to decide, not the Courts. Legislation to give effect to assisted dying will involve very many detailed ethical, legal and practical considerations.

The scrutiny of a select committee process, examining a concrete proposal, is the best and most thorough way of considering this issue.

In terms of appropriate legal process, introducing a Bill to Parliament is the right thing to do.

Morally this is the right thing to do.

The difficulty with assisted dying is that we are attempting to balance competing values, each of great importance.

The first is the sanctity of life and the need to protect the vulnerable. The second is the autonomy and dignity of a competent adult who seeks to end their life as a response to a grievous and irremediable medical condition.

The difficulty is that an absolute prohibition on assistance in dying effectively creates a “duty to live” rather than a “right to life”.

An absolute prohibition on assisted dying also calls into question the existing legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment. Yet already there is a degree of societal consensus that the administration of palliative sedation and the withholding or withdrawal of lifesaving or life-sustaining medical treatment, which can have the effect of hastening death, are ethically acceptable.

Protracted dying was once rare; death typically came swiftly. But medicine has advanced, and now a protracted death is common.

By acknowledging this reality, the argument can be advanced that it is also ethical for voluntary adults who are competent, informed, grievously and irremediably ill, and where the assistance is clearly consistent with the patient’s wishes and best interests, and in order to relieve suffering, for them to have the option of physician assisted end of life.

In short, an absolute ban on assisting another person to end their own life can amount to condemning a person to a life of severe and intolerable suffering.

It was for that reason the Canadian Courts concluded that the ban on assisted dying was too broad – by justifiably attempting to protect the vulnerable, it denied the rights of some individuals in a way that bore no relation to the object of the law.

As the Court said, “A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”

That is why the international trend since the 1990s has been for Parliaments to recognise that, in certain well defined circumstances, an individual’s choice about the end of their life is entitled to respect.

The international evidence was closely examined in the Canadian courts. There it was stated that an absolute prohibition on assisted dying would have been necessary if:

The evidence showed that physicians were unable to reliably assess competence, voluntariness, and non-ambivalence in patients;
That physicians fail to understand or apply the informed consent requirement for medical treatment;
Or if the evidence from permissive jurisdictions showed abuse of patients, carelessness, callousness, or a slippery slope leading to the casual termination of life.
But after an exhaustive examination of the evidence these possibilities were rejected. The judgement found that properly designed and administered safeguards were capable of protecting vulnerable people from abuse and error, that the elderly or people with disabilities are not at a heightened risk, and that there was no evidence of a slippery slope.

Before any changes to New Zealand law are contemplated, these issues should be considered afresh by our Parliament.

Morally, reconsidering the law on end of life choice is the right thing to do.

Politically this is the right thing to do.

My job as a Parliamentarian is to represent the voters, and that involves reflecting the will of the public, insofar as that “will” makes sense and is not inconsistent with my fundamental beliefs.

On this issue, for some MPs, there will inevitably be a clash with some profoundly important religious or philosophical beliefs.

That said, the public clearly wish this issue to be debated, so that regardless of one’s personal view on the matter, this is an issue which deserves to be placed before the House – as I will seek to do with my Bill – and which deserves also to be taken at least to select committee for the sort of thorough review that the Canadian case examined.

Advancing the consideration of End of Life Choice through a Bill to be thoroughly examined via select committee, is the best way to respond to the wishes of the NZ electorate.

I concluded therefore that, politically, introducing my Bill is the right thing to do.

In terms of public policy this is the right thing to do.

The law against assisting somebody to end their life, is of course a ‘generally sound law’. But it is also one which has an extraordinarily harmful effect on a small number of individuals.

As the Canadian judgement determined, that law is overly broad.

As a matter of public policy, we need to reconsider the situation of that small number of persons who:

clearly consent to the termination of their life, and
have a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual.
The eventual scope of any Bill which might be returned to the House from a select committee review is not to be determined here.

My case is that New Zealand needs and - as is evident from recent opinion polls - wants this debate.

Our Parliament should facilitate this discussion by considering this issue afresh through the mechanism of a Bill passing its first reading in the House and proceeding to select committee review.

All New Zealanders should have the opportunity to be heard on this matter. The discussion and review should not be rushed.

My End of Life Choice Bill, when lodged and if drawn from the private members’ bill ballot, will allow this much needed review to occur.

It is the right thing to do.

ends

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