Assisted dying’s risk of coercion
In the second of five articles analysing public submissions on the proposed euthanasia law, Jeremy Rees examines worries about families coercing people to end their lives.
Would families pressure a loved one suffering a terminal disease into taking their lives if euthanasia becomes legal?
“I believe that this law change will be putting vulnerable patients at risk,” Auckland GP, Gisa George says.
“I am worried about the strain this would put on our elderly. Often the elderly feel isolated and vulnerable. Many of them feel that they might be a burden to their loved ones, especially when they need a lot of input and care. If assisted dying is legalised , there is a risk that our elderly might feel that they need to choose this option….”
It is one of the most commonly expressed worries and most vexing questions among the submissions to Parliament Justice select committee on David Seymour’s End of Life Choice Bill. Newsroom is spending the next few days teasing out the main issues that New Zealanders have expressed about medically assisted dying as some of the record 35,000 submissions are released publicly.
Broadly, supporters of the Bill believe that an individual should have the right to choose how they end their life if suffering and that there are enough safeguards to make sure they aren’t coerced; opponents argue the very fact of offering that choice could cause the terminally ill to feel pressured to take it.
One of the striking features of the submissions is the differing views of families - some see them as the centre of support for a dying person, others as the single biggest risk. Some people talk of how family members could be venal. Others just worn out and longing for the terminally ill person to die. Some divided over what to do. Others feeling they need to concentrate on younger members, not the dying.
One palliative care worker described how she sees the best and the worst of families. Some supporting terminally ill members, others bickering, riven and causing stress.
And terminally ill patients may feel a burden.
One submitter, opposed to the Bill, put it like this: “Financial pressure, family breakdowns, misdiagnoses, depression and other mental illness, disability, the desire not to “be a burden”. All of these things (and more) will result in euthanasia becoming an attractive, if not irresistible, option to vulnerable people in society.”A long-time nurse, Bernadette Brocklebank, worries about the subtle pressure that can be placed on the old and ill. “I have been nursing for 38 years, and believe me people, the elderly in particular are without doubt coerced into making decisions by family and others who think they have nothing to offer society.”
In their submission, the Anglican Bishops of Aotearoa/New Zealand, agree. They point to instances of elder abuse. “It is a well-established reality of our society and increasing year on year. Family members and care providers might bring subtle, or not so subtle, pressure to bear on an ageing family member to 'do the decent thing' and exit this life. We have known situations of such pressure driven by family members alarmed to see their inheritance evaporating with the costs of caring for an ageing parent….”
The Royal College of Anaesthetists, too, highlights the subtle coercion that may be placed on a patient, in pain, confused and vulnerable. And it worries how a doctor can spot that coercion.
Proponents of euthanasia or medically assisted dying address the issue far less. To them, the big issue is whether there are enough safeguards in place to make sure people aren’t coerced.
The Bill itself envisages a system in which there are a number of steps to, it believes, safeguard against abuse. First, the person must tell their medical practitioner they want to choose to die and later sign a type of consent form. As well as providing information and support, the doctor must “do his or her best” to ensure that the person is not being pressured by anyone else. The Bill specifically says they do this by talking to other health practitioners who know the person and by talking to members of the family on the approval of the patient.
The medical practitioner must then get a second opinion from another doctor. They, too, determine if the patient would be eligible for assisted dying, although the Bill doesn’t require them to make a call on coercion.
If a patient is eligible, then their medical practitioner must make sure they know they can change their mind at any time.
Among the submitters, whose submissions have been released, is Pam Oliver whose doctoral thesis was on regulations around assisted dying. She pointed out to the Justice Select Committee that lawmakers in countries like Netherlands and Belgium had experience in designing systems that were safe.
“AD (assisted dying) can be regulated to ensure provision of AD as an end-of-life option safely for all people affected, as has been demonstrated by 20 years of safe practice in overseas jurisdictions with societies not dissimilar to New Zealand’s.”
She provided a model bill which included notes for further safeguards, including making sure that there are good interpreters available for people with limited English language skills.
Maryan Street, the former Labour MP who led a petition calling for Parliament to investigate medically assisted dying in 2016, argues that the Bill should make elder abuse and coercion harder.
As president of the End of Life Choice Society she told the select committee that it is hard to see how coercion could escape the scrutiny of two doctors trained to look for it.
“... An argument often used by opponents of MAID (medical aid in dying) is that the elderly in particular will choose ... to end their lives because they do not want to be a burden on others. It is a legitimate and common feeling among many people.”
But patients would still have to meet the criteria and safeguards of the Bill. “The elderly do not qualify ... by being lonely, depressed, feeling as though they are being a burden to others or “have completed their life” and do not want to live any longer.”
They can only qualify under the Bill by a series of criteria; suffering a terminal illness that is likely to end their life within six months or grappling with a grievous medical condition, irreversible decline and unbearable suffering. They must also be able to understand assisted dying and what will happen.
She argued: “...elder abuse is far too common. But there is absolutely no evidence that it occurs within the context of MAID (medical aid in dying).”