End of Life Choice Bill: what does it say?

The End of Life Choice Bill, a member's bill sponsored by ACT leader David Seymour, is currently being considered by Parliament.

The Bill passed its first reading and is now before the Justice Select Committee. The Committee has received 35,000 submissions on it. Newsroom has read most of those released to date.

The select committee is about to embark on a 25 date tour of New Zealand to hear submissions.

What does it aim to do?

Perhaps the best explanation lies in the preamble to the Bill.

“This Bill gives people with a terminal illness or a grievous and irremediable medical condition the option of requesting assisted dying. The motivation for this Bill is compassion. It allows people who so choose, and are eligible under this Bill, to end their lives in peace and dignity, surrounded by loved ones.”

Is that a good thing?

As you’d expect on such a difficult, complex issue, views are divided, although one of the striking things about the submissions on the Bill is their civility; many submitters credited those whose views they oppose with being humane and kind, just arriving at different conclusions whether to allow medically assisted dying.

What are some of the disagreements?

At a moral level, there is disagreement whether the individual should have the right to end their life or whether this goes against society’s basic belief in the sanctity of life.

The process of deciding to die also receives attention. Opponents fear that people may feel coerced into it. So this has put a sharp focus in many submissions on whether the process set out in the Bill is robust enough.

One of the vexed questions is whether assisted dying should apply to people under 18.

Then there is the question of whether doctors, who pledge to support life, can or should actively administer death. Many doctors’ groups are concerned with this.

Are there gaps in the submissions?

Yes, there appear to be surprisingly few submitters looking at the Bill from a Māori or Pacific worldview. 

Why now?

This is a debate which has gained traction around the world and in New Zealand.

In 2015, a Wellington lawyer, Lecretia Seales, terminally ill from brain cancer, went to the High Court for a determination whether her doctor would not be committing murder if he or she assisted in her euthanasia. The judge described the case as being brought “selflessly” to focus on New Zealand law. But the High Court determined it couldn’t make the declarations Seales sought. She died a day after the judgment.

There have been other cases. In 2008, a man was give community service and community detention after he assisted his mother to die. She was suffering from terminal stomach cancer. In 2012, a man was discharged without conviction for assisting his wife, suffering multiple sclerosis, to die.

Other countries have set up assisted dying regimes. It is legal in the Netherlands, Belgium and Switzerland.

So what does the Bill actually say?

The Bill allows for a process for what it calls “assisted dying”.

First, you have to be eligible to apply (and this is where much debate centres).

You have to be:

- Over 18

- Suffering a terminal illness likely to end your life within six months.

- Or, more generally, “a grievous and irremediable medical condition”.

- Moreover, you have to be undergoing “an advanced state of irreversible decline”.

- And experiencing suffering that can’t be relieved or is intolerable.

- Once, a patient has passed those physical tests they have to be aware of what they are doing.

- So, you must have the ability to understand the nature of assisted dying and the consequences.

A person who wishes to be part of “assisted dying” tells their medical practitioner. They then have a number of things they have to carry out.

They have to:

- Make sure the patient isn’t being forced or pressured to do this.

- Give information on the process.

- Encourage them to talk it over with family, friends or others.

- Give them as accurate a prognosis on their illness as they can.

- Regularly check back so the person can change their mind.

Once that is done, the medical practitioner gives the patient a form to sign. If they are physically unable to sign, then a witness can but, interestingly, it can not be someone who would benefit from the person’s death.

The medical practitioner then asks another medical practitioner for a second opinion - and a third, if needed.

If the answer is yes, then the medical practitioner has to discuss it again with the patient, including timing and type of assisted death. For example, they may be offered an intravenous dose which they trigger, or a dose they take orally.

If the patient is set on going ahead, then a time is set down. On the day, the medical practitioner asks again if the patient is sure. If yes, then the dose is administered and the medical practitioner must stay close until the person dies.

The Bill also says that the Ministry of Health must maintain an oversight committee, the SCENZ group (Support and Consultation for End of Life New Zealand). It maintains a list of doctors willing to assist patients die. There would also be a review committee to ensure the law is being administered correctly.

A medical practitioner can opt out of the process due to their beliefs, but the SCENZ group would then provide alternative options to a patient.

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