People suffering at the end of their lives would be offered choice under assisted dying legislation. Photo / Getty Images
COMMENT
The End of Life Choice bill - giving terminally people the option of requesting assisted dying - is expected to go to a Third Reading debate and vote on Wednesday afternoon. ACT Party leader David Seymour's End of Life Choice Bill was amended last month, by a tight vote of 63 to 57, to include a binding referendum on whether it should come into force. A vote in favour after the Third Reading will send the bill to the binding referendum, where the public will be asked to decide. Today, David Seymour presents his case for the bill and registered nurse and specialist youth mental health worker Dion Howard outlines why he opposes it.
New Zealand has never had an assisted dying lobby. The End of Life Choice Society, five Members of Parliament with assisted dying bills, and advocates such as Lecretia Seales, have all been grassroot campaigners.
And yet, New Zealanders hold strong views on the matter. Otago University analysis shows that, over 20 years, support has run at an average 68-15 in favour of choice (with 17 per cent undecided).
Such deep and unsolicited public conviction can only come from one place: life experience. I have listened to New Zealanders from Kerikeri to Gore talk about their experiences. In a nutshell, they say: "I have seen bad death. If my time comes and I'm not doing well, then I want choices. By the way, it's nobody else's business."
A few brutally honest opponents claim that suffering is good for the soul. They needn't use the bill. However, they also needn't inflict their worldview on others.
Most opponents take a more palatable route. They concede the bill would alleviate suffering, but question whether choice for those like as Lecretia Seales could mean coercion for those less determined and articulate.
I started out as someone open to these objections. At the time of Seales vs Attorney General, I would have said "yes, I support choice but is it genuine choice?"
The international evidence answered my concerns. Today, 200 million people live in places where assisted dying is legal. We now have 20 years' evidence about how assisted dying laws work.
Does assisted dying compete with, or replace, good palliative care? No. Jurisdictions with legal assisted dying rank among the best for palliative care and the most improved over the period they've had it. Assisted dying and palliative care work together because, as both sides in Seales admitted, even the best palliative care cannot always help everyone.
Does legalised assisted dying encourage suicide? This question was answered with a resounding no by Parliament's 2016 Select Committee enquiry into the topic. I was there when Ministry of Health officials told certain MPs "there's just no evidence for your belief".
Does legalised assisted dying lead to a "slippery slope" where eligibility widens incrementally? The Supreme Court of Canada "rejected the argument that the adoption of a regulatory regime would initiate a descent down a slippery slope". The reports to the Western Australian and Victorian Parliaments recently delivered similar conclusions.
The reason why is intuitive. Only Parliament can change legislation, and Parliamentarians hate legislating divisive moral issues. Even if they reluctantly revisited it, we'd hear afresh all the arguments that narrowed the present bill in parliamentary debate.
Overseas experience is also valuable for testing concerns about coercion. Do the impressionable and vulnerable get steered into the process? Again, no. Overseas, those with less access to healthcare, palliative care, less education, or minorities use these laws the least. Unsurprisingly, when you think about it, it is those well-resourced, articulate and determined individuals who navigate the substantial procedures and safeguards while very ill.
Some say Parliament has sold out by putting the bill to a referendum. But Parliament must pass the bill to make the referendum possible. Parliament has scrutinised this bill more than any in recent memory, taking 23 months to the day. The net effect of the referendum is that, if Parliament passes the bill, the public will have an additional chance to veto its work. We are getting the best of all democratic worlds.
In the course of its work, Parliament has ensured that: Medical professionals can conscientiously object from acting under the bill. Only the patient can initiate a conversation about assisted dying. Two doctors must independently sign off that the person has a terminal illness, is capable of making their own decision, and indeed is making their own decision. If improper pressure on the patient is detected, the process must stop. The person can change their mind at any time and must be told as such multiple times. The full process set out in the bill would require its own article. These and all other provisions are consistent with other countries' laws and make the bill safe.
Perhaps the strongest evidence that these bills are safe is that none have ever been reversed. The scaremongering we hear just doesn't fit with 88 per cent of Dutch people, for instance, supporting their law after 15 years of experience with it. However, we shouldn't forget why people want these laws in the first place.
Many say we should judge ourselves by how we treat our most vulnerable. What about those suffering terribly at the end of their life? Must they suffer some more to satisfy others' moral expectations? No. We should all be allowed compassion and choice under the law if it happens to us. That's why I'm asking my Parliamentary colleagues to vote "yes".
The debate about legalising euthanasia ultimately comes back to the risks it creates and whether these risks can be safely managed. One of the risks most relevant to a New Zealand context is whether the legalisation of euthanasia will impact suicide rates.
New Zealand has some of the highest suicide rates in the world, now standing at 13.9 per
100,000 people and rising every year. The rate for Māori is almost double that for Europeans and the rates for adolescents and young men in their twenties reaches as high as 36.4 per 100,000.
In an open letter to MPs, 21 mental health practitioners, doctors and academics recently stressed the need for MPs to reconsider the potential connection between suicide and the legalisation of euthanasia.
Consultant psychiatrist Dr Chris Gale, one of the signatories, has noted that many MPs may have a false sense of reassurance on the basis of a departmental report by Ministry of Justice and Ministry of Health officials which concluded there was no evidence that assisted dying would increase suicide rates. Gale says the conclusion seems to have been based on a very cursory analysis of one study in particular, and did not consider other factors, such as statistical patterns being seen in Oregon, the Netherlands and Belgium.
There is already anecdotal evidence of a link between euthanasia and an increase in non-assisted suicide rates as evidenced by numerous practitioners. South Auckland GP Janet Vaughan told the Justice Select Committee: "... we are telling youth that suicide is not the answer [to suffering] and yet, saying to our ... terminally ill that it is. Those youth that have talked to me about the issue have mentioned the double standard."
This resonates with me. As a registered mental health nurse and therapist working with young people who have chronic and persistent suicidal thoughts and urges, I have observed my clients using end-of-life "choice" arguments around bodily autonomy and unbearable suffering to justify their suicidal inclinations. The risk is very real.
While the evidence to date is largely anecdotal, this reflects that no one has yet researched this question. That said, there is more and more "suggestive evidence" emerging, based on international research and statistical analysis, that the introduction of euthanasia potentially will lead to an increase in non-assisted suicide rates.
For example, close examination of suicide statistics in overseas jurisdictions where some form of assisted death is available raises a number of red flags. In Oregon, where assisted suicide has been available since 1997, the non-assisted suicide rate dropped 18 per cent to a record "low" of 13.9 per 100,000 between 1986-1999. However, from 2000 onwards, Oregon's suicide rates steadily increased, reaching 17.7 per 100,000 in 2012. By 2014, the suicide rate in Oregon was 43 per cent higher than the national average.
These statistics support the notion that euthanasia normalises non-assisted suicide within our community and emphasise the need for more research to be done on this issue.
A similar situation exists in the Netherlands, where non-assisted suicides have also continued to rise despite the massive increase in persons dying by euthanasia. In the decade to 2017, the Netherlands observed a 33 per cent increase in non-assisted suicide rates, a statistical trend that goes against the pattern in surrounding European countries which, Belgium excepted, have all seen falling rates of non-assisted suicide. Of further concern is the fact that the increase in non-assisted suicide rates occurred at precisely the same time euthanasia rates in the Netherlands began to climb steeply.
Analysing the statistical trends are more complex for Belgium, which has a similar euthanasia regime to the Netherlands. Between 2002 and 2015, the rates in Belgium fell from 19.50 to 15.80 per 100,000, a drop of 19 per cent. This decline might, initially, seem to undermine the argument that there is a causal link between euthanasia and non-assisted suicides.
However, over the same period, the suicide numbers in Austria fell 31 per cent from 18.6 per 100,000 to 12.90. Similarly, in Germany, rates have fallen 38 per cent over 25 years from a high 17.1 in 1990 to a low 10.6 in 2015. In line with the much larger decline in suicide numbers in these two countries, it would not be unreasonable to expect suicide figures in Belgium would have dropped by a similar rate. So, once again, a causal link to euthanasia cannot be excluded.
So, while Act MP David Seymour continues to deny there is a link, arguing that there is "no evidence for that claim", his claim neither stands up to scrutiny and nor is it based on evidence.
What evidence there is suggests that a causal link to euthanasia cannot be excluded.
If we remain truly serious about curbing suicides and if we are really committed to the Prime Minister's maxim that "one suicide is one suicide too many", legalising
euthanasia in New Zealand is simply too great a risk.
• Dion Howard is a registered nurse and specialist youth mental health worker
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
• https://www.lifeline.org.nz/services/suicide-crisis-helpline
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202
A selection of cartoons from Herald cartoonist Rod Emmerson over the past year