Parliament's Health Committee couldn't decide on any major changes to the End of Life Choice Bill. That doesn't mean, however, that it won't be changed.

The End of Life Choice Bill, a member's bill in the name of David Seymour that would permit aid in dying, has been reported back by Parliament's Health Committee. Because that committee split 4-4 on the merits of the underlying idea - whether people facing imminent death or in a state of irremediable suffering ought to be able to end their own lives with medical assistance - it wasn't able to recommend any significant changes to it.

The Bill's opponents on the Committee weren't interested in backing any changes that might improve its chances of obtaining greater parliamentary support. Consequently, only some relatively anodyne and technical amendments to the existing proposals were agreed to. It is this (somewhat amended, but largely unchanged) Bill that now gets voted on by the whole House at its second reading.

However, David Seymour, as the Bill's sponsor, has indicated that should it pass through this stage he will seek to amend it more substantially during the "committee of the whole House". Basically, this would involve his trying to insert new provisions into the Bill to address many of the concerns that were raised during the select committee process.

Chief amongst these will be narrowing the range of people able to access aid in dying to only those whom two doctors agree have a prognosis of death within six months. In other words, you'll have to already be dying to be able to get medical assistance to die. Also, the decision whether to adopt this law will be handed over to the public by way of a referendum (something that NZ FIrst MPs require in order to even consider supporting the measure).

This first change would bring the End of Life Choice Bill into line with the systems that have been in place in various US states (such as Oregon, Washington, California, etc) since the 1990s. It also would mirror the system that I analysed (and defended) in this academic article back in 2017. So, if you are interested in what I obviously think is the strongest and best written argument in favour of the amended End of Life Choice Bill, have a click and read of it.

 Here's a taster of what I have to say there:

Many of us would prefer not to think about the issue of how and when we will die until we are compelled to do so. Should we turn our minds to such matters, understandable fears and emotions quickly can crowd out our higher reasoning facilities. But it is not necessary to embrace Plato’s assertion that “those who pursue philosophy aright study nothing but dying and being dead” in order to confront the necessary implications of our mortality: even though we may wish to ignore death, it most assuredly will not ignore us. Uncomfortable and upsetting as they may be, questions about the ending we might want for our particular life story and thus what choices we think ought to be permitted in end of life situations are not something that we can or should avoid confronting with clear eyes and an open mind.
...
In this article I argue that New Zealand’s law should be amended to allow at least those competent and consenting adult persons:
  • experiencing unbearable physical or mental suffering;
  • as the result of an incurable and terminal medical condition;
  • where the best medical advice is that death will occur in the next six months;
to directly request that a willing doctor actively help end their life. To avoid repetition, I will refer to those in such a situation as being “relevant persons”. I focus on the case of relevant persons because it provides the strongest grounds for the proffered proposition; if anyone should be able to receive such help to die, it is they. Conversely, I accept that if the argument fails in respect of such relevant persons, then it fails in all other cases as well. The question whether, if successful for relevant persons, the argument then ought to apply to other classes of person—or, indeed, if it is possible to limit the argument’s reach at all—will be addressed in the article’s final part.

Comments (10)

by Graham Adams on April 10, 2019
Graham Adams

Thanks, Andrew, for that analysis. It's clear that opponents also don't want any assisted dying bill — amended or otherwise — to go to a referendum. Despite claiming that the number of opposing submissions to the Justice select committee shows widespread rejection of the proposal, opponents know that a general referendum would probably reflect a majority in support, as polls have indicated over two decades.

by Gavan O'Farrell on April 10, 2019
Gavan O'Farrell

I suppose some opponents of the bill will oppose a referendum, but I suspect that most know that, in a democracy, it must be difficult to decline a referendum if one is offered.

So, if that's the way it goes, time will tell whether the earlier pro-euthanasia polling was truly indicative of the view of the electorate.  Some say it wasn't, because the questions were leading, but we'll see.

The wording of the referendum will be critical.  This article uses "aid in dying":  what's that, financial support?  The bill uses "assisted dying", which is a bit plainer, but the referendum question should state what this means:  "the administration by a medical practitioner of a lethal dose of medication to a person to relieve his or her suffering by hastening death".

Then, people know what they're voting about.  It will be interesting to see what pressure euthanasia advocates apply to soften the language in order to obscure the question.

by Danyl Strype on April 10, 2019
Danyl Strype
I agree with Gavan that the referendum question is critical. I think it will help a lot that however it is worded on the ballot, the question will essentially be; should the bill before the house become law. This may not prevent some proponents making unrealistic promises of benefits, and some opponents scaremongering with nightmarish worst-case scenarios. But hopefully, it will mean that the public can focus the majority of the debate on the specifics of the changes proposed in the bill, and vote on that basis. It would be great to see future referenda, whether initiated by government or citizens, similarly focused around a proposed piece of legislation, rather than the waffly 'how many angels can dance on the head of a pin' questions we've seen in many referenda so far.
by Ian MacKay on April 10, 2019
Ian MacKay

An idea put forward by one Andrew Geddis (I think) was that the referendum should read, "Do you support the End of Life Choice Bill?" Yes/No.

This would dampen the ludicrous scare mongering by such people as Maggie Barrie.

Should also force people to read the final Bill instead of being frightened off with the scaremongering.

by Andrew Geddis on April 11, 2019
Andrew Geddis

Re the above three comments ... I think the easiest and cleanest question would be something along the lines of "Should the End of Life Choice Bill become law in New Zealand?" 

by Lee Churchman on April 11, 2019
Lee Churchman

After (quickly) reading the paper, the usual response to those who want to morally equate voluntary active euthanasia and withdrawal of treatment is, IIRC, that the latter concerns a right not to have things intrude into one's body without consent (which is violated in cases of poisoning, rape, etc.) and respected by the right to refuse treattment (among other things). There is no corresponding general right to demand treatment.This is the common response to Rachels' equivalence argument (at least for some cases). 

by Andrew Geddis on April 12, 2019
Andrew Geddis

@Lee,

True - which is why I can tell every doctor "don't inject me with X" and they must all comply (irrespective of whether they think I'm making the right decision or not); but if I tell a doctor "inject me with X", they can say "no" (based on their belief about what is the best course of treatment, or moral concerns about ). So an equivalence argument that says people have a right to be given aid in dying in the same way as they have a right to refuse treatment is flawed. This is accepted (and reflected both in current law and the proposed Bill).

That said, the medical professions' move towards a patient-centred model where a patient is empowered to choose what form of treatment is best for them in their particular situation is starting to generate an expectation (even if not yet a right) to be able to make such claims on medical practitioners. Whether individual medical practitioners then are willing to meet such expectations is a matter of conscience - which is something that the End of Life Choice Bill recognises. Point being, no doctor would have to provide aid in dying (even if patients were legally recognised as having a right to request it), compared to a situation where a doctor has to stop providing treatment when told to do so by a patient.

However, I think I deploy the equivalence argument towards a somewhat different target, which is the concerns often raised about competence, etc in end of life situations. It's often claimed that we can't allow people to request aid in dying because how can we know whether they are doing so from improper pressure/are properly aware of outcomes/are depressed/etc, etc. My point (which I take from others) is that we already permit such patients to end their lives by making treatment withdrawal requests ... requests that doctors then treat as mandatory because they regard such patients as being "competent" to make them. For, if they didn't believe a patient to be competent to withdraw treatment, then they could ignore the request and continue that treatment (if they believe that to be in the patient's best interests). 

So - my point is, how can doctors routinely accept patients are "comptent" in the latter cases (where, note, there are no second opinions required, c.f. the End of Life Choice Bill), but claim it is impossible to make such determinations in the former?

by Lee Churchman on April 12, 2019
Lee Churchman

So - my point is, how can doctors routinely accept patients are "comptent" in the latter cases (where, note, there are no second opinions required, c.f. the End of Life Choice Bill), but claim it is impossible to make such determinations in the former?

That seems correct to me. 

I realise that you have a different purpose than I do in arguing about this matter, but I do have a different view about the "line-drawing" problem. I guess I'm not alone in thinking it shows that liberalism is a flawed or incomplete moral theory.

While it might not change the answer in this case (and likely won't in my view), it's reasonable to ask what principles ought to restrict individual autonomy outside of incompetence or harm to non-consenting parties. Kant has an answer, which I don't approve of, but at least its a reasoned answer.

Put another way, paternalism is politically difficult but I don't think its necessarily morally difficult.

by Gavan O'Farrell on April 16, 2019
Gavan O'Farrell

@Lee,

You say, "it's reasonable to ask what principles ought to restrict individual autonomy outside of incompetence or harm to non-consenting parties".

Now that is worth discussing.  Our secular society is rushing around in the most difficult moral terrain without a secular morality for which there is anything remotely resembling community consensus.  On the contrary, debates are raging all around us.

Our ethics seem to be piggy-backing on Christianity, topped up with an enormous dollop of unexplained autonomy.  As far as I'm aware, moral relativism is discredited and gone, but the objective ethos of Christianity hasn't been replaced.  Celebrity atheist Sam Harris (and others, presumably) are still trying to stitch an objective secular morality together.

So, one wonders what morality a Select Committee is appealing to when discussing high stakes moral issues like euthanasia.  I suspect it's "Don't ask, don't tell".

by Alex Rahr on April 16, 2019
Alex Rahr

Actual NZ doctors, as opposed to theoretical doctors, can and do mislead and obscure information from their patients in order to deliver what they believe to be the best treatment. I think concentrating on the theoretical doctors will probably mislead you as the real ones are a lot more paternalistic.

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