A Review of the End of Life Choice Act survey
BACKGROUND
Almost three years ago, the New Zealand Parliament passed the euphemistically titled – End of Life Choice Act (EOLC Act). This made legal both euthanasia and physician assisted suicide (PAS) in New Zealand. Since then, hundreds of New Zealanders have ended their lives prematurely through the use of lethal drugs (note, we don’t call such death causing drugs medicine!)
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to remind you of NZ’s current law.
Now the government is reviewing the law. The review has been structured into two parts. The first is for the Ministry of Health to review the operation of the Act. The second is seeking the public’s feedback – and this is where we need your help.
Unfortunately, and in our view, the review by the Ministry of Health is designed to expand euthanasia / PAS in New Zealand. They are only talking to select people and appear to have a starting point that the law is working well, so it is just about how to ‘improve things’. Your public feedback remains important as the answers will be collated and made available to all MPs when a new law is proposed. We expect the likes of the ACT Party and others to push for an expansion of the law, putting even more vulnerable New Zealanders at risk.
So we need your help. The questionnaire is easy to access and use, with fifteen questions. You can access the questionnaire here:
You have until 5pm on Thursday 26 September 2024 to complete it, so please find 10 minutes and complete it today.
YOUR VOICE MATTERS
The politicians responsible for the original law, many in mainstream media, and other pro-euthanasia advocates are very vocal in their support. Alternative voices – such as Family First – are being ignored. This is why your taking 10 minutes to do the review is so important.
Firstly, we need to understand that the current law is not working properly. Reporting around euthanasia is very limited; few doctors and nurses want to be part of the process; and also, the main review committee has never had a full membership – that’s right, they can’t even find three people to fill the roles required by law!
Secondly, all the original reasons for opposing euthanasia / PAS remain. The critical one being that this puts vulnerable people at risk – the elderly, disabled, and sick. We also know that vulnerable people are more likely to feel a burden, be depressed, or worry they are not contributing any more to society. For us here at Family First, we know that all lives have value. It is also why we strongly support palliative and hospice care. This provides all the support needed at the end of life – be this physical, mental, social, emotional, and spiritual. Sadly, in New Zealand, palliative care is not well funded nor available to all people. Instead of paying doctors to end people’s lives, we think the government should be better funding hospices and other palliative care providers.
READ FACT SHEET >>>
to remind you of NZ’s current law.
So what are the big changes that euthanasia advocates want?
As you would expect, they want to expand how many people can access euthanasia / PAS. This is both by increasing the range of conditions that are included (moving away from just terminal illness) but also by increasing the timeframe – so no longer simply ‘six months to live’. Don’t forget, the current law talks about suffering as defined by the patient themselves.
They want to allow medical and health professionals to raise the possibility of euthanasia / PAS with patients. This is very dangerous! Those seriously ill are often very vulnerable and impressionable. It is an incredibly bad idea to put the idea of assisted suicide and euthanasia into anyone’s head at the best times, let alone when suffering.
The possibility of undermining conscience rights. Some are arguing that as euthanasia is now legal, then all doctors and nurses should have to participate when required. This is a direct attack on the rights to conscientiously object. If the law is expanded, even more people will seek assisted suicide and this means even more doctors will be exposed to such requests. It is of paramount importance that doctors and nurses who oppose the idea of euthanasia are allowed to object and not be forced to take part.
There is also some talk of forcing hospices and faith-run facilities to allow euthanasia to be provided on their premises. All good hospices prevent euthanasia on-site as it opposes the very principles of palliative care. If a patient seeks euthanasia, they have the choice to go elsewhere. However, some euthanasia proponents want to force hospices and faith run hospitals to provide assisted suicide.
So please take the time over the coming days to complete the online survey run by the Ministry of Health. It is simple and easy to access.
We have provided a useful resource to let you know the questions, and some thoughts on each one, so that you in turn can write your own thoughts and words.
End of Life Choice Act survey
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Access to assisted dying
Eligibility requirements are set out in clause 5 of the End of Life Choice Act (2019).
A person is currently eligible if they:
Q6. Do you think changes are needed to the eligibility requirements for a person to receive assisted dying? [open comment box]
No. New Zealand should be supporting people more, through the likes of palliative care, rather than helping to end their lives.
Q7. Do you think that changes to areas other than eligibility are needed to support access to assisted dying? [open comment box]
No. There should be no further encouragement to end one’s life. While the current settings are problematic, this question suggests that euthanasia/physician assisted suicide should be promoted more and/or those who object – such as medical/health professionals – need to be coerced into support.
Q8. Do you think the Act provides sufficient safeguards to ensure that people only receive assisted dying if:
a. they are eligible (referenced in clauses 5, 13, 14, 15, 16, and 17 of the Act) [open comment]
No. Diagnosis are well known to be wrong and inaccurate, particularly as to whether ‘six months’ or less.
b. they actively seek and consent to it (referenced in clauses 11, 12, 18, 23, 33, and 34 of the Act) [open comment]
No. Research is clear that people with terminal illnesses are often suffering, or prone to, depression. This alone limits consent.
Those with terminal – or serious – illnesses often talk about being a burden. This indicates the embodying of pressure on them from without, be this from family or wider societal expectations.
c. they are competent to consent to it (referenced in clauses 5, 6, and 15 of the Act) [open comment]
As above, research and information from those working in end of life care, frequently report people suffering from the likes of depression. This limits an ability to consent.
There are also plenty of people who have indicated their desire to seek euthanasia/physician assisted suicide, but glad they did not at the time due to being aware subsequently, that they were in a bad space.
d. this consent is provided without pressure from others (referenced in clauses 11 and 24 of the Act).
No. There is nothing in the current Act that provides any framework in this space. It is solely within the purview of the doctor to detect.
If there is any attempt to remove what is erroneously called the ‘gag’ clause, then there will be an instant and significant increase in pressure. As we know, those suffering or at the end of their life are more vulnerable and susceptible to influence. For any doctor or nurse to plant the idea of euthanasia/physician assisted suicide is wrong and will be a form of pressure – be this explicitly or implicitly.
Q9. Do you think any changes are needed to safeguards provided through the Act?
There are no safeguards in the Act. It is false to suggest there are. What has been described are simply processes.
For example, there are no cooling off periods; no requirement for family to be informed (this remains optional); that doctors described as ‘independent’ are actually only those willing to end people’s lives.
Process to receive assisted dying
Under the Act the process to apply for and receive assisted dying includes:
i. the death being reported (clause 21).
Q10. Do you think any changes are needed to the process to apply for and receive assisted dying?
Yes. A requirement that the doctor/nurse is with the person as they are terminated and must remain until death occurs.
The current situation divorces the doctor from the final process. It also puts the person seeking death a risk, as overseas experience has shown some patients linger, can react to the drugs.
There should be no removal of what is erroneously called the ‘gag’ clause. People at the end of their life are vulnerable and highly susceptible to influence. For any doctor or nurse to plant the idea of euthanasia/physician assisted suicide is wrong.
Practitioners providing assisted dying
Background information…
An attending medical practitioner is central to the assisted dying process. Their role includes ensuring the person has the required information about assisted dying and understands their options for end-of-life care, confirming that the person wishes to apply for an assisted death, and performing the first assessment to determine whether the person is eligible for an assisted death. If the person is determined to be eligible the attending medical practitioner arranges for and administers the medication, or may be assisted by an attending nurse practitioner.
An attending medical practitioner is a medical practitioner who is registered with the Medical Council of New Zealand as a practitioner of the profession of medicine and holds a current practising certificate.
An independent medical practitioner performs the second assessment to determine whether the person is eligible for an assisted death. They must be independent of the person and of the person’s attending medical practitioner. An independent medical practitioner is required to meet the same requirements as an attending medical practitioner, but must have held their practising certificate, or the equivalent certification, for at least five years consecutively.
An attending nurse practitioner can arrange for and administer the medication for someone receiving an assisted death. They are required to act under the instruction of the attending medical practitioner. An attending nurse practitioner is a nurse practitioner who is registered with the Nursing Council of New Zealand, whose scope of practice permits the performance of nurse practitioner functions and holds a current practising certificate.
Q11. Do you think changes should be made to the requirements for medical practitioners and nurse practitioners to provide parts of the assisted dying process?
No. Only those who wish to be part, should do so. Any attempt to extend requirements to other doctors/nurses would be a direct challenge to freedom of conscience.
Oversight of assisted dying
The three entities set out in the Act are the Support and Consultation for End of Life in New Zealand (SCENZ) Group (clause 25), the End of Life Review Committee (clause 26), and the Registrar (assisted dying) (clause 27).
• The Registrar (assisted dying) is responsible for establishing and maintaining a register of approved forms for the assisted dying process, reviewing the assisted dying forms completed by practitioners to ensure compliance with the Act, receiving and managing complaints (including referring them to other appropriate authorities), reporting annually to the Minister of Health about the number of deaths occurring through assisted dying, and taking any action as directed by the End of Life Review Committee.”
Q12. Do you think changes are required to the roles and responsibilities of the entities established under the Act to oversee assisted dying?
Yes. The End of Life Review Committee needs to be fully constituted. It never has been to date, with vacancies for roles. This is unacceptable for such a serious piece of law – literally life and death. The failure to have done so indicates significant process issues and calls into question what other processes are flawed.
Alignment with the wider health system
Q13. Do you think the assisted dying process aligns with other parts of the health system?
No. It is the antithesis of health care. The first principle of medicine is ‘do no harm’ (primum no nocere). Providing drugs to end a person’s life is an act of harm. It damages the person and the health system.
Experts across many fields have also noted that euthanasia/physician assisted suicide is incompatible with palliative care.
Q14. Is there anything that could be improved?
There needs to be substantially more funding to palliative care in New Zealand.
Reporting needs to be more public. This would include release of most of the details required by clause 21 of the Act, although not any personal identifying aspects (be this patient, medical practitioner etc)
I note that the duration between the drugs administered and death occurred is deliberately notrequired by the Act. This should be included.
Other feedback
Q15. Do you have any other feedback related to the Act?
Euthanasia and physician assisted suicide are not needed in New Zealand. End of life care should be about caring for someone till natural death, using the extensive supports available via palliative care which addresses the physical, mental, social, and spiritual needs of people.
The current Act distorts medical practice; explicitly suggests that some lives are not worth living; and implicitly says to those in our disabled and ageing communities that their lives are not as valuable as younger or more abled people.
Now the law is in place, the continual push to expand the scope is happening as was predicted by proponents.
The functioning of this law remains clouded by a lack of transparency and a failure to follow the simplistic review structures already in place. This in itself should be raising concerns even before the ethical implications are considered.
The law should be repealed however, seeing this review process appears designed to enableexpansion of the law, then it is critical that no changes in scope, eligibility, or conscience rights (for medical/health practitioners) should be made.
Finally, this whole review process is highly questionable. The Ministry’s review of itself (in effect) is very narrow, including choosing who they will talk with. Secondly, that these public submission comments have no bearing on the review itself. While useful to have a collation of the public’s thoughts, it is concerning that these thoughts are explicitly to be ignored by the review.
Almost done…
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