Is assisted dying a Pākehā issue?

In the latest of Newsroom's series analysing major themes in public submissions on the proposed euthanasia bill, Jeremy Rees looks at ethnic and cultural considerations.

Is interest in euthanasia or assisted dying a Pākehā issue?

That is one of the questions being raised in submissions on David Seymour’s End of Life Choice Bill which, if passed, would make it legal to apply for medically assisted dying.

Newsroom is monitoring the discussion points as the record 35,000 submissions on the Bill are progressively made public by Parliament’s Justice Select Committee.

So far, the issue of euthanasia and race is raised in three different ways.

First there is the question of whether the Bill takes into account worldviews of Māori, Asian or Pacific people.

That leads to the second question, a philosophical one: Is there a disconnect between people who say there should be an individual human right to choose to end one’s life (an idea seen as a Western one by some submitters) and others who see life in collective terms, by saying we belong to families, whānau, groups or society and those relationships trump the individual (an idea seen by some submitters as being more in accord with Māori, Asian and Pacific peoples).

Thirdly, are ethnic minority groups submitting their views on the Bill? This, too, is being asked in submissions. There are submitters who identify themselves as Māori, Asian and Pacific people among the thousands of submissions released so far, but the numbers are small.

(There could be a number of reasons for this; the way the submissions have been drip-fed, for example, or perhaps discussing ways to die is a universal thing. But it is worth bearing in mind as debate continues on the Bill).

The idea of euthanasia as a European issue is most explicitly raised by the body which represents psychiatrists. The Royal College of Australian and New Zealand Psychiatrists points out there is little discussion in the Bill of how Māori or minority ethnic groups might view assisted dying. It goes on: “While the relationship between euthanasia and ethnicity is not well-researched, experience from Oregon and Washington in the US indicated that people who died of physician-assisted dying were predominantly White American.”

Among the submitters who question whether the bill has taken into account Maori views are the Anglican bishops of New Zealand and the New Zealand Nurses Organisation.

The submission by the Anglican bishops says the bill needs to take care not to over-ride the views of Maoridom where "caring for the extended family in all circumstances is a priority."

The body which represents Maori nurses, Te Runanga o Aotearoa of the New Zealand Nurses Organisation, said it is "extremely disappointed" there is no reference to Maori views in the bill or "tikanga Māori processes with death and dying in this Bill, individual versus collective decision making responsibilities, and inclusion of Kaumātua, or cultural expertise" on the overseeing body of the bill.

It urged the Justice Select Committee to consider other models.

The issue is echoed in a submission by GP Dr Janet Vaughan who works in a low-income South Auckland medical practice with mostly Māori, Pacific and Indian patients. “I have not encountered the desire to end life or this intense need for control and autonomy that was present in the previous white middle-class practice that I worked in.”

She said her patients believed their families would look after them, they trusted their families to help them and didn’t see themselves as a burden. She argues that many supporters of euthanasia seem to be better off, well-educated New Zealand Europeans and that Parliament needs to seek far more diverse voices on the Bill.

“I have concerns that this is yet another situation of unconscious cultural imperialism at work on a populace that is no longer predominantly aligned with a Western worldview.”

The InterChurch Bioethics Council, a body set up to look into biotechnology issues and supported by the Anglican, Methodist and Presbyterian churches, said it too had fears that an “individualistic” and “rationalist”, largely Pākehā viewpoint would be used in the Bill rather than considering other ways of thinking, like Māori and Pacific peoples.

“Within Māori and Polynesian communities, euthanasia/assisted suicide is not part of everyday reality or something readily discussed.”

One of the identifiable Pacific voices among submissions released so far is that of the Reverend Victor Pouesi of the Congregational Christian Church of Samoa in Mangere East. He argued that life is sacred, should be treasured at all costs, that euthanasia could lead young people to consider suicide and that God would determine the time of a person’s death.

He said he had witnessed God perform a miracle with a man in an intensive care unit who was considered by doctors to be irreversibly dying only to recover to become a chief orator in his church. “I therefore suggest we must give people the sense of treasuring their lives as the most expensive commodity.”

Another is a group of Tongan doctors and community leaders in the PACYFIC Trust (Pacific Child, Youth and Family Integrated Care Trust) and they too argue against the Bill, on the grounds of the difficulty of defining eligibility criteria and over fears of fallible human beings having to decide who can die.

Of the submissions released so far, few from supporters address how the Bill could work with ethnic communities. But that may not be surprising; supporters are writing in to voice support for the Bill. There are, however, discussions how euthanasia can fit Christian beliefs.

In her submission, former Labour MP Maryan Street, now President of the End of Life Choice Society, said many supporters of assisted dying are Christian or religious.

“Many of our ethical positions in New Zealand are common to people of faith and people of no particular faith because they are derived from our Judeo-Christian heritage.”

Sanctity of life is central to Western medicine but it was not an absolute; for example, a soldier could kill in a “just war”.

The ethical assumption in favour of life “is a central tenet of our civilisation”. But, “for the individual, it is precious only when it is worthwhile. In some cases, the individual will find the release of death to be more important than hanging on to a miserable existence of unbearable suffering or stretching out the end in a terminal disease. In other words, the harm caused by death is to the individual who loses some time in life; but, for some individuals, death which brings an end to suffering is not harm, but a benefit.”

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