In two months, New Zealanders will vote on a major social shift: whether to legalise voluntary euthanasia. Photo / 123rf
Euthanasia could soon be legal in New Zealand, but what exactly would that mean?
Could a patient tell their GP they want to die on a Wednesday and be dead by the weekend?
Is it inevitable that the proposed euthanasia law would be expanded from the terminally ill to those with depression? Or to children? And how secure are the safeguards?
These are some of the debates taking place in public meetings, on social media and over family dinner tables.
As part of the Herald's ongoing coverage of the euthanasia and cannabis referendums, we take a look at some of the most headline-grabbing arguments around voluntary euthanasia and whether they stack up.
It is one the most common arguments against voluntary euthanasia - that making it available for a small group of people, such as terminally ill adult patients who are in decline, will inevitably lead to it being broadened to more people, such as those with mental illness or young people.
Opponents usually point to the examples of the Netherlands and Belgium, where people can get access to euthanasia on the grounds of psychiatric illness, and where there is no minimum age for eligibility.
But there is no evidence that broadening the law is inevitable wherever euthanasia is legalised.
A Joint Select Committee in Western Australia reviewed international research on the issue in 2018 and concluded: "[Opponents to assisted dying] assert that a particular course of action will inevitably lead to another action, with unintended consequences.
"In other words, it implies something out of control or unmanageable. The committee finds no evidence to suggest this has occurred in the jurisdictions that have legislated for voluntary assisted dying.
"Each jurisdiction has its own unique legal framework resulting from considered legislative processes and court rulings in those countries. The Oregon legislation, for example, has never been amended in its 20 years of operation."
In some cases, it is wrongly believed that a law has been extended to mental health patients. The Netherlands and Belgium euthanasia schemes have always been available to people in this category.
In other cases, laws have been liberalised after being introduced. Belgium removed the minimum age limit in 2014. Since then, people as young as 9 have ended their lives.
The Western Australian Joint Committee said while the removal of the age limit expanded the scope of the legislation, it was not evidence of a slippery slope. It was deliberate and considered reform.
Supporters of the End of Life Act say safeguards included in the bill will limit the scheme only to those who are in unbearable pain, able to make an informed decision, and are near the end of their life.
One of those safeguards is that a person has only six months to live.
However, medical experts say predicting when a person will die is an inexact science. Dr Michal Boyd, Associate Professor at the University of Auckland's School of Nursing, said clinicians were wrong in predicting death within six months 25 per cent of the time.
Boyd also said cancer prognosis was becoming less certain as more effective therapies were developed for treatment. Cancers could develop into a chronic illness and no longer be life-limiting, she said.
National MP Chris Penk, one of the most vocal opponents of the End of Life Choice Act, has said that a person who chooses to die will be able to do so within a few days.
"It would be possible for a person to receive a diagnosis of terminal illness on a Wednesday, gain the necessary approvals under the bill that same day, and be dead before the weekend," he said during debate on the law change.
Penk is referring to a "cooling off", "stand down" or "reflection" period. In Victoria, Australia, a patient must wait nine days between making a decision and taking or being given a lethal dose. In Canada, it is 10 days. The measure is designed to prevent people making rash decisions about ending their lives and having no time to reflect on it. There is no such provision in the New Zealand law.
A report by the justice and health ministries confirms that in a hospital setting, the minimum time between a person requesting assisted dying, going through the various checks, and dying under the New Zealand law would be an estimated four days. If they were at home, it would be an estimated 15 days.
However, the ministry said this assumed all parties were available, there were no objections, and no concerns about competency. As a result, the estimated timeframes were likely to be much longer. The ministry said in practice, the process could take months.
One of the main themes in the opposition to the End of Life Choice Act was that vulnerable people could be pressured to end their own lives. Hypothetical scenarios included a family pressuring an elderly relative to die to claim their inheritance, or parents of a disabled person pushing them to die to relieve their "burden".
The Western Australian committee, having considered international evidence, concluded that vulnerable groups - disabled, minorities, people from poor households, children, dementia patients - were not more likely than others to access assisted dying or euthanasia.
Analysis of deaths in the United States, Canada and Europe found those most likely to access assisted dying were old, white, well-educated and relatively wealthy.
Under the New Zealand law, if at any point a doctor suspects a person is being pressured, they have to stop the process.
There is evidence that some people feel a "duty to die" in countries where euthanasia is legalised. This is harder to safeguard against.
In the US state of Oregon, more than half the people who died through voluntary euthanasia in 2018 cited "burden on family, friends/caregivers" as one of their reasons for choosing to die. However, it was likely to be one of many factors in choosing to die. More than 90 per cent of people who died also cited loss of autonomy or being unable to engage in activities, which made their life less enjoyable.
This is a particularly sensitive issue in New Zealand, where youth suicide rates are among the worst in the developed world. Some opponents of voluntary euthanasia make no distinction between suicide and assisted dying, and are concerned that legalising euthanasia will legitimise death as a response to suffering, leading to a rise in suicides.
A US study in 2015 found suicide rates had risen in states that had legalised assisted dying - but this is disputed in academic literature. A review in 2017 found the increase was not statistically significant.
In European countries that legalised euthanasia, suicide rates have remained steady or fallen.
As with all of these arguments, the international experience of euthanasia can tell us only so much. Experts stress New Zealand has unique social, cultural, political and other factors that will influence how this country could respond to a legalised framework.
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• Legal cannabis has potential to reduce harm, but many unknowns: PM's chief science adviser
• Covid-19 coronavirus: What does our response say about how we could react to legal euthanasia?
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