There’s a slow, slow train comin’ up around the bend

It's pretty much just a matter of time until aid in dying (or, "voluntary euthanasia", if you're wanting to scare the children) law reform arrives in New Zealand. A couple more signposts for that journey were erected in the last few weeks.

It appears that the Health Select Committee's inquiry into Maryan Street's petition, which itself called for Parliament to "investigate fully public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable", has attracted a record number of submissions. A figure of over 22,000 has been mooted.

That fact doesn't particularly surprise me. After all, voices on both sides of what should be called the "aid in dying" debate were active in urging participation in the process. And the issue is one that excites passions on either side - indeed, it may mark as fundamental a matter of moral disagreement as there is.

Furthermore, it's an issue that continues to bubble away even as the Committee slowly churns away with its inquiry. On this weekend's The Nation, Australian campaigner Andrew Denton and the Care Alliance's Matthew Jansen conducted a neither very illuminating nor respectful discussion of the topic. It's a shame that the opportunity descended into little more than sloganeering and accusations of mendacity.

Nevertheless, while the precise timetable and details of the issue's journey are as-yet unknown, I think its final destination is clear. As five Australian medical law academics recently noted at the conclusion of their review of the various (so far unsuccessful) attempts to introduce aid in dying laws in that country:

The authors predict that [aid in dying] law reform is likely to occur in Australia. There is a convergence of factors that make this issue increasingly difficult for politicians to ignore: high and sustained public support for reform in Australia; an ageing and increasingly informed population seeking choices for their end-of-life experience; the changing legal landscape internationally; and the media’s interest in the topic and, particularly for social media, its agitation for change.

In my opinion, you can substitute "New Zealand" into that prediction without any resulting loss of accuracy. As with same-sex marriage or marijuana decriminalisation/legalisation, aid in dying simply is a policy that better fits existing societal beliefs and expectations than does the status quo position.

A couple of recent developments buttress that claim. First, earlier this month the Victorian Parliament’s Legal and Social Issues Committee tabled an extensive report on on its inquiry into end of life choices. This report proceeded the way that NZ's Health Committee really should have done - it first examined how the State's palliative care services are operating and what should be done to better improve this, before then turning to look at the issue of aid in dying. With regards that latter matter, the Committee concluded that:

Assisted dying should be made available to adults with decision making capacity who are at the end of life and suffering from a serious and incurable condition, which is causing enduring and unbearable suffering that cannot be relieved in a manner they deem tolerable.

Suffering as a result of mental illness only does not satisfy the eligibility criteria.

Assisted dying should be provided in the form of a doctor prescribing a lethal drug which a person may then take themselves, or in the case of a person being physically unable to take the drug themselves, the doctor administering the drug.

The request to access assisted dying must be completely voluntary, properly informed, and satisfy the verbal request, formal written request, repeat verbal request procedure described [in the report].

There's a bunch of reasons why we should care what this Committee thinks. First up, it represents the conclusions of a group of MPs from a society that is (like it or not) pretty similar to our own. What is more, the report represents a cross-party near-consensus on the issue. The Committee consisted of three Labor MPs, three Liberal MPs  and one representative each from the Sex Party (yes - really!) and the Greens. Of these eight members, only one (from the Liberal Party) dissented from the recommendation.

[Update: Thanks to Matthew Jansen in comments for pointing out a rather significant mistake on my part - there were actually two separate minority reports, one from a Liberal and one from a Labor Party member. My apologies for misleading.]

So you can't just dismiss this report as the ideologically driven predetermined views of [insert whatever side of the political spectrum you disagree with].

Second, the conclusions reflected some quite intensive study of the topic at hand. Not only did the Committee avail itself of the literature on the issue and hear from 100 witnesses – including medical specialists, legal experts, and terminally ill people and their families – but it spent 13 days in the Netherlands, Switzerland, Canada and the US meeting with people involved in the aid in dying issue there and studying first hand what actually is happening in those places. As a consequence, the Committee majority felt able to dismiss some of the more commonly made claims about what happens when aid in dying is made available: it doesn't inevitably create a "slippery slope", it doesn't lead to the vulnerable or disadvantaged being pressured into death, it doesn't increase suicide rates, etc.

Finally, these are politicians grasping the nettle and calling on Parliament to act. That matters because it appears to me that aid in dying is the sort of issue that representative democracy struggles with. It enjoys (so opinion polls say) wide but (I suspect) fairly shallow support - by which I mean that most of those who favour it don't regard it as that high priority a matter. On the other side is narrow but much deeper opposition from those who appear genuinely to believe the issue is an existential threat to society/the medical profession/etc, etc. The forces produced by that divide are very hard for elected representatives to navigate, which is why most of them really, really don't like having to confront the matter. (Honourable mention here to David Seymour for his "End of Life Choice Bill", of course.) So for Victoria's MEP's to do is, I think, an important marker of where the debate is going.

Whether the Victorian Committee's report actually then translates into legislative change in that State is something we'll now just have to wait and see. But the other development I want to mention does involve actual legislative provision for aid in dying: Canada. Just last week this nation's Parliament voted into law a regime to allow access to aid in dying for (again) terminally ill individuals who have a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; and who are suffering intolerably.

The background to that legislation and what it says is an interesting story in itself. I've written a bit on it here, while there's been some fascinating back-and-forth between Canada's (elected) House of Representatives and its (appointed) Senate since then. But once again its relevance for New Zealand ought to be clear. Canada is a lot like here, and Canadians are a lot like us. In fact, switch hockey for rugby, pine forest for bush, throw in some bears and moose and you've pretty much turned NZ into British Columbia (complete with insanely overvalued housing in its main city).

So now that Canada has brought in a regime of legalised aid in dying, we've got a near perfect comparator for us as a nation to see if the claimed negative consequences of the practice eventuate. Will Canada's introduction of aid in dying somehow harm the practice of medicine (or, at least, the practice of medicine in end-of-life situations)? Will it lead to elderly/depressed/disabled people being pushed by relatives or money-saving governments to end their lives? Will the suicide rate, especially for young people, trend upwards because of "mixed messages" about the practice? Etc, etc?

Or, will nothing in particular happen except that some relatively small number of individuals who are suffering a serious and incurable illness, disease or disability; are in an advanced state of irreversible decline in capability; and who are suffering intolerably as their foreseeable death approaches are able to gain a quicker and more merciful release than having to rely on the vagaries of nature? And if that is the case, then isn't that a pretty good signal that we here in New Zealand should extend the same sort of mercy?