His comments come as the Ministry of Health is conducting a mandated review of the End of Life Choice Act within three years of its implementation to assess its effectiveness and determine whether amendments are needed.

The current review will be finished by November.

Kleinsman was speaking on 1 News.

Changes needed

Kleinsman say the current legislation needs changing as it lacks:

• a formal assessment for coercion
• a requirement for an independent witness during the assessment phase
• adequate screening for depression and other mental health issues
• no cooling-off period after a request is made

He recognises that the case for assisted death is motivated by a desire to show mercy to those suffering.

While individual cases may appear justified without immediate harm, concerns arise about the cumulative impact of cases and shifting public perceptions, he says.

Kleinsman warns that the growth of habits and attitudes of mind gradually reshapes public perceptions of what is happening and what assisted dying means.

He points to several international examples that cause concern.

Countries like the Netherlands, Belgium, Luxembourg and Spain now permit assisted dying for mental illness, with several other countries also allowing it for minors, infants and individuals with dementia.

Then, in a related development, a 2023 Canadian poll revealed that 28 percent of respondents supported assisted dying for individuals experiencing homelessness, while 27 percent were in favour of those living in poverty.

The findings have fuelled further controversy as stories emerge in Canada of patients opting for assisted dying due to inadequate social support and healthcare rather than an autonomous choice driven by their medical condition.

"This shows us a glimpse into our own future if we loosen our eligibility criteria - the price could involve "severe unintended consequences" Kleinsman said.

He adds that we must continue to protect the integrity of palliative care and have AD-free spaces. Many people want this, and it's essential for upholding real choice.

He says that to replace the requirement for a terminally ill patient's life expectancy to be under six months with a clause like "grievous and irremediable suffering" would be wrong.

Forbidding doctors to raise the option of assisted dying with a patient must not change, he says.

Pro assisted dying changes

Social Justice NZ CEO Jackie Foster says she voted "no" at the referendum but has changed her mind.

Foster said, after losing her mother to cancer and having a close friend aged 51 die from a degenerative disease, it is often difficult for doctors to determine if people will die within six months, so she wants the removal of that time restriction.

She wants two changes to the legislation -

• the removal of the words "within 6 months" from section 5(1)(c)
• inserting a new sub-section 5(1)(g) into the Act that says "suffers from a degenerative disease that will ultimately end their life"

Foster believes that the first three years of this legislation have brought the country closer on the issue.

In 2020, 65 percent of voters said "yes" to the legislation but she believes that number would be higher today.

Source

• 1News

Health Minister Shane Reti (himself opposed to assisted dying) and the coalition partners are drawing up the review's terms of reference.

While Act Party leader David Seymour, who instigated the Assisted Dying laws, would like changes made to the eligibility criteria, he accepts nothing's likely to change any time soon.

The review itself won't change the law, he says.

That's because the review outcome is simply a report to Parliament. It will probably make some recommendations, but there was no requirement for the government to pick up the changes or Parliament to debate it.

It's more likely an MP will take the recommendations and put them into a member's bill which will need to be pulled from the ballot to be considered, Seymour explains.

Timeframe change needed

At present, assisted dying is available only to terminally ill adults with fewer than six months to live.

Seymour wants the "cruel" six month timeframe to be scrapped.

Auckland's Totara Hospice - the only one in the country offering assisted dying on its premises - would "at best like to see that timeframe removed, or extended to twelve months".

"The Act says suffering is defined by the patient so we don't see the need for a time requirement to be put on suffering" chief executive Tina McCafferty says.

The 'gag clause'

Seymour and McCafferty want the rules preventing doctors from discussing assisted dying to change. At the moment, patients must raise the question with their doctor.

McCafferty says that restriction is "at odds with the actual responsibilities of healthcare professionals ... to inform patients of all choices they can have in their care".

"Not everyone is articulate when it comes to health literacy, and I want to see that potential bias or inequity mitigated" she says.

Hospice NZ chief executive Wayne Naylor agrees. He also wants the clause clarified and provisions for family bereavement and grief support considered.

Law review does not equal law change

Seymour says the government is not obliged to take any action on the review recommendations nor is Parliament required to debate them. The review in itself won't change the law.

Furthermore, the coalition government had to "speak with one voice".

"I know there are people in the Cabinet who would say it would actually conflict with their conscience to have to support this legislation" he says.

Whatever changes are recommended, there are a couple of restrictions Seymour does not want altered.

One is that end-of-life choices are restricted to mentally competent people.

The other is that these people must be adults.

"For me, children have always been out, [and] people who have lost the capacity to decide for themselves are out" he says.

Source

• RNZ

Hundreds more explored the service but chose not to proceed, she says.

However, Young's conversations with 19 individuals who opted for euthanasia paint a picture of the inner turmoil and the weight of making such a final choice.

According to her research, many did not foresee the difficulty in setting the date and time for their own death.

Young describes the waiting period as a double-edged sword.

While it provided time to say goodbye, it also initiated a distressing countdown.

"Waiting for the day to arrive was an opportunity to prepare themselves and their families and friends for death but, for some, it felt like an unwelcome countdown - and choosing it was very tricky" says Young.

Young acknowledged that it is not an easy task for providers to euthanise people, and families of those who chose to die this way described it as a bittersweet experience.

"Families are both relieved that their loved one is no longer suffering, but also it's really hard to have this date hanging over your head of when you will die ... it's bittersweet.

"Before the assisted dying law came in there was so much discussion about how contentious this was and it is certainly a sensitive subject," she says.

"But the stigma from colleagues that assisted dying providers expected has largely not eventuated, which is great" says Dr Young.

Young says she has not encountered much stigma from people disagreeing with people's decision to be euthanised.

She says she recently started discussing euthanasia applications with cancer patients, their families and physicians and is describing the feedback as positive.

However despite the positive feedback, Young found that those being euthanised experienced gaps in the service.

"Patients who wanted counselling found that some of the professionals they spoke to were ill-equipped to discuss assisted dying" she says.

"Providers said they faced a steep learning curve in terms of navigating the eligibility assessment requirements and the Ministry of Health portal, and families said that there was a big gap in support after death for them."

• Counselling and Support

Source

• Stuff

He's concerned about ACT Party leader David Seymour's desire to widen the End of Life Choice Act criteria. Seymour argues the change is necessary, as many who want assisted suicide are "missing out".

Seymour says this is mainly because those people don't have a terminal illness likely to end their lives within six months.

The six-month terminal prognosis requirement prevents those with chronic conditions or disabilities from being eligible.

Betty argues broadening the eligibility criteria would not improve equitable choice for those facing end-of-life decisions.

It should not progress in light of the current palliative care climate in New Zealand, he cautions.

Nor should it happen without careful analysis.

Despite its supreme importance to New Zealand's health system, palliative care is not well catered for, says Betty.

"There's no strategic plan as to what is going to happen with palliative care, there's fragmented services, lack of funding… the list goes on. It's not a situation we can allow as a first-world, caring society."

The contrast and imbalance of palliative care vs assisted suicide and euthanasia is sizeable and cause for concern, he says.

"We have one part of the system fully-funded and overseen in an apparently coherent way by the Ministry of Health (assisted suicide and euthanasia), and the other sector that doesn't even have a strategic plan in place, that is inequitably funded, and has no coherent overview of how to develop the service.

"Why don't we have the exact focus on palliative care, so anyone making the biggest decision of life can make an equitable, informed choice?"

It's remiss of the Government, politicians and the Ministry of Health, he says.

Betty says New Zealand's 5,500 GPs, specialist GPs, trainees and rural hospital doctors often provide palliative care to their patients free of charge.

That's because there is no funding available for end-of-life care - a serious failing of the system, he says.

"Palliative care is so dependent on local funding, which is traditionally done by DHBs, but there's a total lack of funding, resourcing and a national approach."

This, coupled with a growing workload and an increasing complexity in clinical patient needs, adds pressure to palliative care practices.

"The question becomes - why don't we have that exact same focus on palliative care," Betty says.

The Assisted Dying Service Data and Report from 7 November 2021 to 30 September 2022 says only about 80 percent of those choosing assisted suicide or euthanasia have access to palliative care.

Betty cautions against this analysis.

"It doesn't show perceptions of what is going on or the quality of care they are receiving," he says.

The data's effectiveness should be questioned when the Act is reviewed, he adds.

"Everyone is affected by death and dying. That is part of health. Good dying and having equitable choice is a fundamental part of the healthcare system we set up. It has to be given space and focus at this point."

Source

• Scoop
• NZ Herald
• 1News

A year after coming into force, the End of Life Choice Act is working well and opponents of the law change had "melted away," Seymour says.

"The figures overwhelmingly show a law that is working. People can and do get through the process to become eligible for assisted dying, some change their mind, some are assessed as not eligible. That is what we'd expect if the law was working."

In the year since the law was passed, 214 patients have been euthanased.

In all, 596 people have applied, and 294 have been deemed eligible and 120 people were turned down because they were not eligible.

Seymour says a third of the ineligible patients were declined because they didn't meet the criteria of having a terminal illness likely to end their lives within six months.

He says he suspects "some if not many have an illness that is terminal but without a certain timeframe."

Seymour says he agreed to the six-month timeframe to gain the Green Party's support to pass the bill.

"I fear that compromise is leading to people ... missing out on having choice and control, even though their long suffering is just as real as those with a more immediate terminal condition."

His original bill would have allowed non-terminal patients with "grievous and irremediable conditions" to get access to voluntary euthanasia.

The amended law, which was voted on in a public referendum, made it explicit that applicants could not get access to assisted dying on the basis of disability or mental illness alone.

Seymour says he will argue for the euthanasia law criteria to be broadened when the law comes up for review in 2024.

He is also concerned that one in six applicants had died of underlying conditions before they were able to get an assisted death.

"It's excluding people with long-term conditions, and that means a lot of suffering that may not be necessary," he says.

Better palliative care

While Seymour wants the law relaxed, health experts are calling for wider support for palliative care services.

Royal College of GPs says it's too early for any new legislation changes.

The College is calling for ongoing observation for the next 12 months.

The Royal College of GPs medical director, Dr Bryan Betty says he'd like more funding for palliative care services sector-wide.

"There is underfunding for hospice, there is underfunding for specialist palliative care services, and there's under-funding of palliative care to general practices which support patients who are dying."

Since December 2021, numbers seeking end-of-life treatment have risen from around 15 per month to around 20 in September 2022.

Source

• NZ Herald
• One News

Experts say we already have a "postcode lottery" determining who dies in pain.

The scale of the problem contrasts with the provisions of the newly available End of Life Choice legislation.

The new legislation offers a fully-funded system to enable terminally ill people who meet exacting criteria to end their lives.

But, if a terminally ill person wants palliative care and to end their lives naturally and in comparative comfort, funding is chancy.

Much of it comes from the likes of selling strawberries and second hand clothes.

"Looking to the future is a nerve-wracking experience, as we see costs increasing but no sign of a commitment from Government to help us with the additional costs," Mary Potter Hospice chief executive Brent Alderton​ says.

"It is ironic that the new end-of-life-choice service is fully funded and our hospice care funded less than 50 per cent."

The hospice makes up the rest itself - from second-hand shops, bequests, donations, events and reserves.

This year's Strawberry Festival fundraiser, however, was cancelled due to Covid-19. The Hospice already had a $100,000-plus deficit from last financial year.

Danielle van Dalen​ of the Maxim Institute says the need for palliative care in New Zealand is expected to increase by 50 percent in the next 20 years and double in the next 50 years.

The pandemic's disruptions to fundraising have resulted in some palliative care services having to dip into savings for the first time, she said.

"If funding doesn't go up, along with other things, more people will have bad deaths."

Sue Sutherland, who is the general manager of marketing at Nurse Maude, says the Government provides about 70 percent of hospice service funds. Like the Wellington hospice, they have to fundraise the rest.

If the forecast increase for hospice palliative care becomes a reality, there would need to be a rise in Government funding "so everyone who needs palliative care can continue to receive it," Sutherland says.

Health Minister Andrew Little says the Ministry of Health is already looking into improving the "equity and quality of palliative care...".

Talks with those working in palliative care show there are already areas needing improvement, he says.

The Government funding for palliative is currently set at $490.7 million over four years.

It gave an additional $20m for four years in 2019 and a $7.3m boost in 2020 due to Covid-19.

College of General Practitioners medical director Bryan Betty (pictured) said the Government should have fully funded palliative care when it brought out the End of Life Choice Act.

He says the current underfunded palliative care system created an "uneven playing field".

Funding to provide good quality, consistent palliative care is needed throughout New Zealand, he says.

Source

• Stuff
• Image: Freemasons NZ

The End of Life Choice Act means people enduring unbearable suffering from a terminal health condition and have a life expectancy of less than six months may now ask for medical help to end their lives.

Provided those preconditions are met, any person aged 18 and over may request voluntary euthanasia - a situation that will potentially impact thousands of New Zealanders.

Disability advocate Chris Ford has two big concerns. One is that the legislation isn't broadened to include vulnerable groups.

The other concerns keeping complete records and statistics of those choosing assisted dying.

As regards to the possibility of the legislation being broadened, Ford says this: it is vital it is not further extended to cover, for example, people with psychosocial disability/mental distress or children and young people under the age of 18.

Both of these extensions have happened in recent years in Belgium and the Netherlands, with people from both groups being helped to die, Ford says.

Those of us opposed to voluntary euthanasia should be on our guard in relation to changes to the legislation, he says.

He points out that some of the Act's key proponents have vowed to have the law amended at the first available opportunity - even before the Act's first mandated review is completed in five years' time.

His other concern is possibly unanswerable. "Will we ever truly know that each and every person who opts to take this path has done so of their own free will?" he wonders.

"I hope that the vast majority of people will have done so without coercion but my fear is that some (including a not disproportionate number of older and disabled people) will be at greater risk of manipulation by well-meaning (and perhaps not so well-meaning) family/whanau, friends, and other networks, meaning that effectively they will have had no choice in the matter."

Ford says this is why he will be looking at the early statistics of people who have chosen to end their lives to see whether any clear patterns emerge.

"I will be particularly interested to see the age, ethnicity and gender composition of the people who do so," he says.

Ford will be looking for data about their geographical locations and - most he says importantly for him - whether they self-identify as people who live with pre-existing disabilities/health conditions/impairments which they have had prior to contracting terminal illness.

"I hope the ministry will collate disability data around this too as they are often remiss in doing so when it comes to other health-related data," he says.

Based on overseas experience, the Ministry of Health estimates about 950 people will apply a year, with up to 350 following through with the option.

The Otago Daily Times reports "It is widely recognised that collecting information on all the whys and wherefores of the process will be important to ensure the Act works as it should."

Source

• Radio NZ
• Radio NZ
• Otago Daily Times
• Image: Otago Daily Times

The Support and Consultation for End of Life in New Zealand group (SCENZ) is charged with maintaining and providing a list of medical practitioners and psychiatrists as part of the service when required.

The 11-person group will "support the development of the standards of care for medicines as part of the implementation of the [End of Life Choice] Act".

Appointed by the Director-General of Health, the team will serve a term for two years. Read more

Ministry of Health officials have highlighted "complex and sensitive elements" to the End of Life Choice Act and incoming assisted dying regime in a briefing paper to Health Minister Andrew Little.

The paper had been given to Director-General of Health Dr Ashley Bloomfield in January, highlighting numerous unresolved questions and risks surrounding assisted dying services.

Among the "elements" include "uncertainty" over how many people will seek assisted death, terminally ill patients having to travel for services when the law comes into effect, competing pressures in the health system, and a possible need to rewrite parts of the law to resolve "legislative issues".

A statutory body, Support and Consultation for End of Life in New Zealand (SCENZ), will include up of 11 medical experts who will manage the incoming assisted dying regime.

SCENZ will develop and oversee the standards for terminally ill patients should receive when they seek an assisted death.

Although the ministry says work to implement the new Act is "well underway", legal action over assisted dying services is considered "almost certain", due to the "strong views from sections of the public in favour and against assisted dying".

Dr John Kleinsman, the director of The Nathaniel Centre for Bioethics sees "a tragic irony in the fact that the Ministry of Health is able to put so many resources into enabling assisted death, and fully funding it in our country, when palliative care is not equitably available and also not fully funded.

"Advocates of the law change campaigned for change on the basis of choice, but for too many people they won't have the choice to access quality end of life care.

"I am not surprised by the prospect of further legal action. On the one hand, the Act is a terribly weak piece of legislation and I and many others, including lawyers and health practitioners, pointed out its many problems when the Bill was being considered.

"Too many MP's chose not to listen."

"Many proponents of the new law made it abundantly clear at the time it was passed that they thought it too restrictive! So they will be pushing hard for the law to be expanded. It is what has happened in every other jurisdiction and it will happen here."

Although Little has been approached by media about the Act in recent weeks. he has not been available.

The three "key risk factors" health officials identified in the briefing paper given to Little and Bloomfield are that: parts of the health sector are refusing to be involved in assisted dying; competing resources and pressures in the health system; and inadequate or insufficient engagement with "stakeholders" within the short timeframe to enact the law.

A "key question" is whether assisted dying should be fully government funded, or a "mixed-model". How a mixed-model could work was not detailed.

The legislation, which was a members' bill, may need to be rewritten "to ensure that the Act functions as intended", the paper said.

Source

• Stuff
• Supplied: The Nathanial Centre for Bioethics
• Image: Stuff

The Act comes into force on 7 November.

The big pastoral issue revolves around whether or not to give the last rites to people who choose assisted suicide or euthanasia.

The last rites include three sacraments: Confession, Anointing of the Sick and Dying and Holy Eucharist. These sacraments are given to Catholics seriously ill or in danger of dying.

Dunn says the bishops have discussed this issue at their last bishops' Conference meeting. At this, they agreed "to seek wider input" on the issue.

"We have got to be careful," Dunn says.

"The bishops are concerned about offering these [rites] to people being euthanised, but are seeking feedback."

This will include looking at what's appropriate in terms of giving guidance and advice to those who are thinking of availing themselves of assisted suicide or euthanasia.

There are dilemmas such as whether priests should "sit by the bed while the doctor's doing the injection saying the prayer for the dying."

" It's a bit odd, isn't it?" Dunn says.

So far the bishops have agreed it might be acceptable to hear the confession of those who choose assisted dying.

In doing so, they would ne, "hoping all the time this might help them to not go ahead with what they're doing," Dunn says.

But any decision the bishops make will be structured so it cannot undermine the position of Catholic medical practitioners, who refuse to take part in assisted suicide or euthanasia because of conscientious objection.

Dunn says the bishops were disappointed with the passage of the Abortion Legislation Act and the End of Life Choice Act. They did all they could to prevent these from becoming law, Dunn says.

"It's like a tide. This (euthanasia) is one of the terrible signs of the times. How do we respond as a Church?"

"In some ways, all we can do is keep emphasising what we believe and then try to show the compassionate face of the Father."

"All we can do is to keep affirming the worth and the preciousness of every human life, even though we are living in a situation which we find so abhorrent," Dunn says.

Dunn says it seems the ordinary person thinks assisted suicide is a compassionate act, a merciful thing.

"The trouble is — this sort of act can have a creeping effect. The big fear is that old people or chronically unwell people could begin to feel‘well, I'm a burden on my family, a burden on society. I'm no good. My life has no value. I just want to end it'.

"It actually has consequences that are negative for society. I sort of hope in a way that it won't be taken up much, but you never know."

Source

• NZ Catholic
• Image:NZ Herald
  

Assisted dying will become legal from 6 November 2021.

The preliminary referendum result at last month's election shows 65.1 percent of voters supported the act and 33.8 percent opposed it.

The New Zealand Medical Association (NZMA) opposed the changed law. However, its chair Dr Kate Baddock says now the results were out, the NZMA says it will work with its doctors and with the public to improve understanding of the act and its implications.

Braddock says the NZMA aims to "ensure everybody understands what the act will entail and what people's obligations, responsibilities and options will be."

New Zealand doctors will be allowed to be conscientious objectors of euthanasia.

Braddock says one of the first steps will be to create a list showing which doctors want to be part of the process.

"Doctors will be making their choices well before the 12 months are up as to how they feel about being engaged - first of all in the process of decision-making and then the execution of the medication itself."

No-one knows what the next year will entail, she says.

"It's going to be really important as an organisation that we engage with our membership over what the provisions of the law mean. So as a doctor, what does it mean precisely in terms of your responsibilities and your options."

The Royal College of General Practitioners is neutral about the new End of Life Choice Act. Its president Dr Samantha Murton says the College will advise and support its members through the transition.

"There'll have to be training and learning about the legislation, how it works, what your requirements are, what you do if you think someone is under coercion, how do you access the services if you don't want to do it yourself."

A lot of planning around logistics will be needed, Murton says.

"There might be places where you don't have two doctors to be able to provide the services in a particular centre, there may be logistics around that."

"It's just making sure all the checks and balances are in place and that the system's very robust and people know how to access the services if they want it."

Given the work to do and the timeframe, implementing the law will need "extremely good management," Murton says.

It is anticipated many of those who choose to access euthanasia will be terminal cancer patients.

The Cancer Society is neutral on the issue.

"I would never want to see anyone presented with the false choice of either suffering or assisted dying, because that is not the choice that should be available to people. It should be excellent supportive care with all possible efforts to relieve suffering made in all cases, at all times," its medical director Chris Jackson says.

Source

• RNZ
• Image: New Zealand Parliament

NZMA says it goes against medical values and is a "step too far" for many doctors.

NZMA chair Kate Baddock says while the association opposes the concept of euthanasia, it would work through the details of the Act before it came into effect next year.

She says the majority of medical professionals are against assisted dying.

"The main concerns for doctors is that it alters the fundamental relationship with the patient.

"There is going to be lots of implications which need to be worked through in some detail."

Coercion is an issue NZMZ says it must be "particularly careful about coercion. It could be so subtle no one picks it up."

Over 1800 doctors signed an open letter opposing assisted dying, entitled "Doctors say No", stating that assisted dying is unethical, regardless of whether it is legalised.

NZMA says the outcome has created a "complex" situation for medical professionals, particularly in rural areas with few GPs.

Doctors will work within the legal framework and just as they can with abortion, will be able to conscientiously object to taking part in ending lives.

Bioethics expert for the Catholic bishops, Dr John Kleinsman (pictured), says it puts vulnerable people and those who care for them on an unwelcome and dangerous path.

Kleinsman says the Act will bring a new and unwelcome dynamic into many people's lives.

"The very presence of the option of euthanasia will present as a burden and a pressure for many people and families," says Kleinsman.

Those who work with the dying will also be affected, he says.

These include doctors, nurses and other health carers, as well as chaplains, priests and lay ministers.

"We will be reflecting in the coming months with these groups as to how the law will impact the people they care for, as well as the carers themselves. Among the questions raised will be ones about the provision of the sacraments at the end of life, and the impact on funeral celebrations."

Friday's preliminary results saw 65.2 percent of votes cast in favour of the End of Life Choice Act, with 33.8 percent against.

Assisted dying is defined in the End of Life Choice Act as a doctor or nurse practitioner giving a person medication to relieve their suffering by bringing on death, or, the taking of medication by a person to relieve their suffering by bringing on death.

Those opting for an assisted death have to be 18 or older and suffering a terminal illness likely to end their life within six months.

The official results will be released this Friday.

Source

• NZ Catholic Bishops' Conference
• Stuff
• Image: Stuff

Firstly, though, I want to help you think about the concepts of justice, love, compassion, mercy and caring not merely on a spiritual or emotional or philosophical plane, but in a grounded way.

What do I mean by that?

Reality is defined by the challenges thrown up by our own weaknesses and the weaknesses of others, including the flawed institutions that we move in and out of and that sustain us.

Reality is also perhaps defined by our personal fears, both real and imagined, which limit our vision and can cause us to renege on our ‘yes' to what is good and life-giving.

Cultural and social context

A few facts about the social and cultural context in which we currently live that I believe are relevant to the introduction of assisted death in NZ?

• It's a context in which more than 10% and rising of our elders are experiencing abuse, including physical and emotional neglect, mostly from their own family members. This despite the tightest of laws against such abuse - WHY?
• It's a context in which more and more people, our elders in particular, are feeling socially isolated - WHY?
• It's a context in which depression is on the rise while our mental health services are under stress.
• It's a context in which people who are elderly, disabled and dependant are increasingly feeling like they are unwelcome and a burden.
• It's a context in which our health system is under increasing financial pressure to provide the care people need in a fair and equitable way.
• It's a context defined by severe institutionalised racism because Maori and Pacifica people die on average 7 years earlier than the rest of us and are 2.5 times more likely to die of diseases or illnesses than the rest of us.
• It's a context in which quality palliative care is not equally accessible?

We need to ask

What sort of social and cultural dynamic will be created were we to enact the End of Life Choice Act in this context?

In my view, there has never been a more dangerous time to legalise assisted death as at this particular time in our New Zealand history.

• What does it mean to care about others as much as ourselves in this context?
• Will providing assisted death address any of these issues in a caring ethical way?
• Will it resolve the inequity issues for Maori and Pacifica or worsen them?
• Will it address the social isolation of our elders or will it add to a sense of abandonment?
• Will it resolve the issues of increasing elder abuse or mask them? Will it address the inequitable access to palliative care or compound the current shortcomings?
• Will it really be "good care" to introduce assisted death in this context?

The questions I am posing are not questions about the rightness or wrongness per se of assisted suicide and/or euthanasia.

Actually, the question about the contextual implications - which is essentially a justice question - poses an even more important question for us as voters than whether assisted death is morally right or wrong.

This is precisely what the NZ Catholic Bishops are speaking about in their recently released Election Statement where they write:

"An informed decision requires consideration of the economic, social, whanaungatanga-kinship and cultural factors that limit many people's freedom to choose. Well-intended laws can have significant negative repercussions because of matters not anticipated by the law or because we don't all have access to the same choices.

"In coming to an informed decision, we advocate that voters embrace a perspective that gives priority to the impact a law change will have on others: ‘How will such a law affect us as a community? Who will be most negatively affected by the law in question? What are the consequences for those who are most vulnerable?"

Haves and have-nots

I am not saying that this law won't work for some, for example, the likes of Sir Michael Cullen, who has been a vocal, articulate and very public supporter of the Act.

Sir Michael is not one of the people I worry about in terms of being vulnerable when it comes to this law.

He already has choices, lots of choices.

He is articulate and well-connected.

He clearly has a good understanding of what is involved in the law. I do not have a fear that he will be coerced.

There are many others in the same position as him - able to talk about accessing the best of palliative care until they want to take control over the last few days.

For Sir Michael and others like him, legalising assisted death will provide another choice to add to the many choices for healthcare he already has.

Neither am I particularly concerned about myself being coerced into an assisted death.

I am also articulate and in a position where my saying ‘no' comes out of a place of having a family who will care for me whatever; comes from a place of knowing that I also have the choice to access quality palliative care so that I don't have to endure pain in the event I have a terminal illness.

Both Sir Michael and I, and may others are among those people capable of dying (or not dying) in a way that the Act allows … more than capable of making a truly free choice that is not the result of being bullied or coerced.

So, no, we don't have to deny that the law will work for some … but will it work for all and, in particular, will it work for the most vulnerable?

To draw again on the words of St Paul - it's about caring for others as much as, and not less than, we care for ourselves.

Taking on the same attitude of Christ Jesus is not to look at the Act from the perspective of the strong and articulate - those who have power and the luxury of choices - but rather to look at it from a perspective that considers the impact on the vulnerable - those who are disempowered and on the margins and who lack basic choices including access to good healthcare.

Not voting on law about assisted death

My experience is that most people know very little about the actual law.

My fear is that many, if not most, who decide to vote yes will decide to cast their vote based on their belief that some form of assisted death is a good idea - it's all about choice, right?

My fear is many, if not most without any reference to either the context in which we live or the robustness of the Act itself.

But we are not voting on the idea or concept of assisted death.

We are voting in this referendum on a particular law - a law that differs in critical ways from other laws overseas because it lacks many of the safeguards present in those laws; a law I regard as poorly drafted and weak.

1. There is no mandatory stand-down period in the End of Life Choice Act as there is in other countries. Under the proposed New Zealand law, a person could be dead less than 4 days after diagnosis. Hawaii has a 20-day stand down.
2. Unlike overseas laws, the EOLC Act does not require independent witnesses in the decision process.
3. A person does not need to be competent at the point when they make the final decision to die, unlike overseas laws.
4. The NZ Medical Association and the College of GPs have noted that there are no processes for effectively detecting pressure or coercion - a doctor simply has to ‘do their best'.
5. There is no screening for depression and no requirement to assess or provide mental health support?
6. There is no specific test for competency required. Rather, under the Act, the starting point for a doctor is that everyone is presumed to be competent unless it is obvious they are not - that is an extremely low threshold.
7. A person with a terminal illness does not need to be in pain to avail themselves of this law. It is not an act of last resort as many think. Up to 25,000 people will fall within the scope of this Act annually - in some ways, the structure of the Act makes it more akin to an ‘opt out' law rather than an ‘opt in'!
8. A person with a terminal illness does not need to try palliative care first!
9. The Act does not provide for a legal right to access palliative care - overseas, people are choosing assisted death because of a lack of other choices and it is well accepted that palliative care is not yet universally accessible in New Zealand.
10. It will not protect our elders who are being abused, mostly by their own families, from a premature death. Elder abuse affects 10% of our elders and continues to rise.
11. Neither of the two doctors need to know or have met a patient previously.
12. Neither of the doctors has to be a specialist in the area of your life-limiting illness as is the case overseas or be a specialist in palliative care.
13. All eligible persons, 18 years plus, can end their life without telling a family member or significant other.

Do we want a law at any cost?

It's important to know that, if it passes, the Law will be enacted in its current form - it cannot be changed.

My own conclusion, and that of almost 200 lawyers who have signed up to a website called Lawyers for Vulnerable New Zealanders, is that the End of Life Choice Act is, from a legal and public policy perspective, poorly drafted and lacking in key safeguards found in other laws overseas.

And some of these lawyers support the concept of assisted death!

Good public policy does not provide choice for some - the privileged - at the cost of caring for and protecting the most vulnerable.

In contrast, having the same attitude of Christ means taking a preferential option for the disempowered and vulnerable.

• It's not ‘compassion' to vote for a dangerous law.
• It's not mercy to vote for a dangerous law.
• It's not caring to vote for a dangerous law.
• It's not justice to vote for a dangerous law.

Even those who favour assisted death in some circumstances have many good reasons to vote no to this Act.

• Dr John Kleinsman is Director of The Nathaniel Centre and bioethics researcher.

He is ignoring the repeated clarification that this is not the case.

However, that being said, there is another more fundamental issue; Seymour appears to belong to what Professor Robert George calls a "pseudo-religion", variously known as secular progressivism or expressive individualism.

"It functions like a religion," George says, "it is a source of meaning, it has got a set of dogmas; indeed it has a lot of the other indicia of religions. Saints and demons and holy days . . .

He says the idea that secular progressive ideology counts as neutrality is "deeply foolish."

One of the dogmas of this pseudo-religion is that "competing 'comprehensive views', be they secular or religious, certainly religious ones like Christianity, Islam, Judaism . . . must be restricted to the private precincts of the home or house of worship".

As with militants and fundamentalists in any religion, it brooks no dissent.

"They can't allow for freedom of conscience or freedom of speech or any other basic civil liberties. They want conformity; they want 'group-think'."

"Now why should anybody of any competing faith accept those terms?" George asked.

"We compete fairly in the public square with you... you have no authority to shut us down."

"You make your arguments, we will make our arguments and then we are going to use the processes of deliberative democracy to resolve the questions until they get opened back up in the ordinary institutions of democratic governance for reconsideration, if, indeed, they do.

George is director of the James Madison Program in American Ideals and Institutions at Princeton University.

He was speaking in a Facebook interview with New Zealand's Brendan Malone of Left Foot Media on September 7.

Source

• youtube.com
• nzcatholic.org.nz
• Source: independencedaily.co.uk

Donnelly and Seymour appeared on TV3's Newshub Nation on Saturday morning.

Donnelly said the proposed Act is a "dangerous law" that will put the lives of 25,000 vulnerable people at risk.

"I think that it would be a lot more respectable if instead of making up these kinds of what I call 'false objections' if Dr Donnelly came here and said 'this choice is against my religion, and I don't want other people to be able to make that choice'.

"It would be a lot more respectable if she would say that," Seymour said in reply.

Donnelly was visibly shocked.

"That's a disgraceful, sectarian comment.

"I have 25 years of experience in palliative medicine, I speak from a professional point of view, I'm an associate professor of palliative medicine, research and education, I've worked in four different countries - so I speak from that platform and that experience.

"I deeply care for people - that's all I care about. Four generations of doctors in my family... I know we can relieve their suffering through palliative care.

"Palliative care works".

Donnelly said Seymour's comments were "bigotry at its utmost".

"I've travelled literally from Kerikeri to Gore campaigning for this law," Seymour said.

"I've heard the stories of New Zealanders who have seen bad death. No matter how much people try to say 'just a bit more palliative care, it's going to be okay' they know what they've seen. They want to have that choice of dignity and control.

"It's their life - it should be their choice. It's not up to others to tell them that they should stick around a bit more to fit someone else's morality."

Donnelly explained some of the common objections to the proposed law.

These include fears people will be coerced into ending their own lives. She also pointed out that some people make miraculous recoveries after being close to death.

"Prognostication is an estimate... we get it wrong most of the time. Even within a few days of death."

"Families often ask 'how long have they got to live?'

"We generally say we're not sure, we don't know... It's not as if we plug in the patient's details into a computer and out pops a date of death," Donnelly said.

Source

• Newshub
• Image: Newshub

In a statement on the End of Life Choice Act, Seymour singled out New Zealand's Catholic Bishops and told them they needed to follow the ninth commandment and to 'stop bearing false witness against their neighbours in political debates".

Suggesting a view in a public debate which is different to his is a false witness, (a lie), Seymour's statement threatens, "If the Bishops want their freedoms respected, they need to engage in honest debate that respects others have difference [sic] choices from theirs."

Seymour's comments come after 37 of New Zealand's most prominent religious leaders, including the New Zealand Catholic Bishops say New Zealanders need to be aware of the considerable harm that the End of Life Choice Act could do.

The statement is authorised by Archbishop Philip Richardson, Primate, Senior Bishop of the New Zealand Pakeha Diocese and Bishop of Diocese of Waikato and Taranaki.

The leaders say that in their caring roles they come face to face with people who are dying and their families, and they understand how vulnerable people are at the end of their life.

"Our concerns are about the unintended consequences for the most vulnerable", the religious leaders say in the statement.

They say their communities include lawyers who think the End of Life Choice Act is badly-drafted law and that it lacks critical safeguards present in similar overseas laws.

They also say they have listened to the concerns of doctors who work on the front line of end-of-life care.

"Our opposition to this Act reflects our compassion for those who will experience a wrongful premature death because of the dangers of this Act; in particular those who will feel coerced into an early death, whether because of their own feelings of being a burden or because of overt pressure from others", the leaders say.

The religious leaders point out that the referendum is a binding referendum, meaning the Act will be enacted in its current form and cannot be changed.

The leader's statement reads

At the upcoming general election, you will be asked to vote in a binding referendum on the End of Life Choice Act, 2019.

We the undersigned religious leaders, wish to share with you our grave concerns about the final form of this Act.

We speak out of our extensive experience of caring for the dying.

We know the effectiveness of compassionate end of life palliative care - care that is able to address not just the physical suffering of people who are dying, but also their emotional, spiritual and psychological suffering, as well as that of whanau and friends.

Medical practices that are part of good end-of-life care - ceasing treatment, Do Not Resuscitate Orders, Advanced Care Directives and turning off life support - are already legal and part of our health care choices and are not part of this proposed law.

The referendum question is not about the desirability of some form of ‘assisted dying'. Rather, we are being asked to vote on a specific piece of legislation - the End of Life Choice Act. The key consideration for all of us is the robustness and safety of this Act. Our concerns are about the lack of safeguards in the Act and the dangers it would present.

We note that the Act differs in the quality of its processes and safeguards from other laws overseas:

• The Act is not just designed for a small number of hard cases. It is broader than laws in Victoria and the United States because it allows both assisted suicide and euthanasia.
• This is not an Act of ‘last resort' - there is no requirement to try effective treatments or palliative care. There is also no corresponding right in the proposed law for people to access palliative care.
• People will be able to access an assisted death without being in any physical pain. Overseas statistics show people choose assisted death primarily out of a fear of being a burden and/or being disabled.
• The Act does not require a patient to discuss their decision with a family member or other significant person. All eligible persons, 18 years and over, could choose an assisted death without family knowing.
• There is no mandatory psychological assessment or effective screening for depression. Research shows that requests for an assisted death are commonly influenced by depression, something that is extremely difficult to detect and often mistaken for ‘appropriate sadness'.
• The NZ Medical Association and Hospice NZ, who oppose the Act,3 share concerns that it lacks processes enabling clinicians to be confident a person is making their request free of pressure from others.
• The two doctor ‘safeguard' is weak; neither of the doctors needs to have met the person previously.
• There is no mandatory stand-down period as there is in other countries - under the Act, a person could be dead less than 4 days after diagnosis.
• Unlike laws overseas, there is no requirement for independent observers or witnesses at any stage.
• The Act does not require a person to be assessed for competency at the time when the lethal dose is being administered, as is the case with laws overseas.

The referendum is binding, meaning the Act cannot be changed - it will be enacted in its current form.

We are also concerned that the practice of assisted suicide and euthanasia will become normalised over time, leading to a broadening of the criteria for eligibility as seen overseas.

There is also evidence showing that people choose assisted death because of a lack of adequate care options. There is a risk this will also happen in New Zealand, especially because effective palliative care is not yet universally available to all.

We acknowledge the importance of exercising freedom of choice.

At the same time, there is a need to balance individual choice with the common good of society. On balance, we believe that the significant weaknesses and dangers of the Act strongly outweigh the benefits that supporters of euthanasia seek.

• Archbishop Philip Richardson - Primate, Senior Bishop of the New Zealand Pakeha Diocese and Bishop of Diocese of Waikato and Taranaki
• Bishop Jay Behan - Church of Confessing Anglicans, Aotearoa New Zealand
• Pastor Steve Burgess - Regional Director, C3 Church Pacific
• Commissioner Mark Campbell - Territorial Commander, Salvation Army, New Zealand Territory
• Bishop Patrick Dunn - President of the NZ Catholic Bishops Conference; Catholic Diocese of Auckland
• Dr Mustafa Farouk QSM - President, The Federation of Islamic Associations of NZ (FIANZ)
• Rev Tavita Joseph Filemoni - General Secretary, Wesleyan Samoan Methodist Church of New Zealand and Australia
• Charles Hewlett - National Leader of the Baptist Churches of New Zealand
• Rev Brett Jones - National Superintendent (Acting), Wesleyan Methodist Church of New Zealand
• Right Reverend Fakaofo Kaio - Moderator, The Presbyterian Church in New Zealand
• Metropolitan Myron - New Zealand Greek Orthodox Church
• Rev Dr Stuart Lange - National Director, New Zealand Christian Network
• Pastor David MacGregor - National Director, Vineyard Church Christchurch
• Rev Andrew Marshall - National Director, Alliance Churches of New Zealand
• Pastor Peter Morlock - Senior Pastor, City Impact Churches of New Zealand
• Archbishop Don Tamihere - Primate, Pihopa o Aotearoa and Pihopa o Te Tairawhiti
• Rev Setaita Taumoepeau K. Viekune - President, Methodist Church of New Zealand
• Pastor Adam White - Leader, New Life Churches of New Zealand
• Bishop Mark Whitfield - Lutheran Church of New Zealand
• Bishop Ross Bay - Anglican Diocese of Auckland
• Bishop Steven Benford - Anglican Diocese of Dunedin
• Bishop Peter Carrel - Anglican Diocese of Christchurch
• Cardinal John Dew - Catholic Archdiocese of Wellington
• Bishop Michael Dooley - Catholic Diocese of Dunedin
• Bishop Justin Duckworth - Anglican Diocese of Wellington
• Pastor Max Faletutulu - Senior Pastor, Titahi Bay Community Church, Wellington
• Bishop Michel Gielen - Catholic Diocese of Auckland - Auxiliary
• Bishop Andrew Henge - Anglican Diocese of Waiapu
• Bishop Stephen Lowe - Catholic Diocese of Hamilton
• Bishop Steve Maina - Anglican Diocese of Nelson
• Pastor Kaio Mamea - Light of All Nations Church, Wellington
• Bishop Paul Martin SM - Catholic Diocese of Christchurch
• Bishop Te Kitohi Pikaahu - Pihopatanga o Te Taitokerau
• Bishop Waitohiariki Quayle - Pihopatanga o Te Upoko o Te Ika
• Rt Revd Dr Eleanor Sanderson - Assistant Anglican Bishop of Wellington
• Bishop Richard Wallace - Pihopatanga o Te Waipounamu
• Rev Brian Walsh - Local Administrator, Catholic Diocese of Palmerston North.

Sources

• ACT New Zealand
• Religious leaders' statement

But the conference specifically takes issue with the proposed End of Life Choice Act that is the subject of the impending referendum.

"I think it will change the way we are as a society ... how we think about old people, how we think about people with a disability."

Kleinsman says as Catholics they are not interested in "imposing" their beliefs on others, and they understand there is a case to be made for euthanasia.

However, he pointed to several issues within the Act of concern to the Catholic bishops, including the absence of a 'cooling-off period', which he believes makes it a "dangerous" piece of legislation.

He says that in a context where elder abuse is rife and "rising" despite a "very clear, robust law" prohibiting such abuse, the question:

"If we can't keep [them] safe now, how do we think we could keep them safe?" has to be asked if such a law was to pass.

The Christian church promotes the idea of autonomy and self-choice, but "we are not individuals in isolation and assisted dying is "not the only way to have a dignified death," he says.

Kleinsman says any euthanasia regime relies on the idea that some lives are worth living while others are not: "if anything, those most vulnerable deserve the greatest protection and care."

He says compassion and mercy are at the core of what it is to be Christian but says it is compassion towards those who will be sucked in unwittingly and experience wrongful death that forms the basis of his opposition to the Act.

Kleinman's statement forms part of a piece about the End of Life Choice Act on Stuff that canvases several opinions about the proposed legislation.

Source

• stuff.co.nz
• Image: assets.change.org

There have been the inevitable losses of parents, something for which, despite the inevitability, you're never quite prepared. And the sudden passing of those mates you thought you'd grow old with. Each of those deaths has been unique.

Some have been swift and merciful, others harrowing and haunting. There has been beauty and compassion to be found in all of them.

They have all brought something special to those intimately involved in the caring process.

I have come to realise it's not death I fear but the suffering that comes with it for so many.

For there has been suffering, suffering no amount of palliative care can allay.

In just under two months we will be asked, in a public referendum, to choose whether or not to support the End of Life Choice Act.

The Act will open the door to Euthanasia or medically assisted dying, for people in the final stages of a terminal illness.

If more than 50 per cent of us vote ‘Yes', then the Act will become law.

It's one of the most important and far-reaching legal decisions we will make in our lifetime.

Caralise Trayes's book, The Final Choice: Is assisted dying the answer? comes along at an opportune time.

Trayes is a journalist of 10 years experience, formerly at Fairfax Media.

Her style is chatty and generally straightforward. Her book consists of a brief history and summary of the Act and a series of interviews with those whose views cover both ends of the spectrum, with lawyers, advocates, palliative care specialists, those who have actively considered taking their own lives, and those who will be at the sharp end of implementing the law if and when it passes.

The right to end suffering is what David Seymour says his bill is all about.

Trayes's book voices concerns over whether the bill has been clearly thought through.

• Are there enough safeguards against coercion?
• Will euthanasia become normalised?
• Could it become economically expedient?
• What becomes of the mental health of those required to administer the fatal dose?

A number of overseas jurisdictions where euthanasia is legal - Canada, Belgium and the Netherlands among them - have reported an increase in requests for euthanasia as time goes on.

The Belgians and the Dutch have now extended their law to cover children and people with dementia and mental illness.

Before Covid, the Netherlands parliament was about to consider draft legislation that proposed anyone over 70 could have assisted dying irrespective of any medical necessity.

The proposed law is targeted towards people who are lonely, bereaved or "disattached."

What of the elderly and chronically disabled who may be feeling they are a burden to their families? Does the Act protect the vulnerable, the weak, the lonely? Will the "right" to die ultimately become "the duty" to die?

At the heart of the book is the question: why is it that people want to die? Continue reading

As specialist doctors trained in palliative medicine and currently practising in New Zealand, we're extremely concerned at their argument in favour of euthanasia.

It's wrong and it's dangerous says Dr Sinnead Donnelly, a practicing palliative care specialist.

First, they argue in favour of euthanasia because, in their words, palliative care has been "underfunded from the start and access and quality are patchy".

They say that aged residential staff "are overworked and often poorly trained in palliative care for the dying".

In other words, they want us to vote at the referendum in favour of euthanasia due to inadequacy and inequity of palliative care and inadequate aged residential care staffing.

This is a little like arguing that the car needs a clean so should be pushed off a cliff. When have we, as a society, agreed to prematurely end the lives of patients due to poor funding?

In any other situation that would be called callous and unacceptable. It certainly doesn't pass the kindness test.

The second irresponsible statement is that "the End of Life Choice Act is one of the safest in the world".

It is not.

The Act's claimed protection against pressure from "another person" is poorly drafted and provides inadequate levels of protection to vulnerable New Zealanders.

For example, the Act requires only one doctor (the first doctor to whom a request for euthanasia or assisted suicide is made) to only "do his or her best" to ensure that person requesting euthanasia has expressed their wish "free from pressure" by "any other person".

The Royal New Zealand College of General Practitioners, the very doctors who are also going to be on the front line of the process, told Parliament they won't be able to detect coercion or pressure in all cases with this test, and that there will be wrongful deaths under this law. To wit:

"The College ... considers clause (h) where the medical practitioner is required to 'do his or her best to ensure that the person expresses his or her wish free from pressure' is problematic.

"As one member wrote: 'It will prove impossible to determine if a patient is 'free from coercion'.

"What criteria will doctors use to determine whether or not coercion exists?

"If patients request assisted death, there is no provision in the Bill as to what a doctor should do if she or he thinks that coercion is actually present.

"Coercion of patients will be impossible to discern in every request for assisted death.

"Doctors will not be 100 percent correct in their assessments of coercion. Wrongful deaths will be the result of this proposed new law.'"

It's for this (and many other) reasons that both the World Medical Association and the New Zealand Medical Association state that euthanasia is medically unethical.

It's no surprise then that more than 1500 New Zealand Doctors have signed a petition under the 'Doctors Say No' banner.

It's not just doctors sharing this concern.

Richard McLeod, representing Lawyers for Vulnerable New Zealanders, has advised that: " ... under the Act a person could be dead within only a matter of days after being diagnosed, and without needing to tell any loved ones.

"There's no mandatory cooling-off period between a request and the final lethal injection.

"That's a serious flaw because terminally ill people can go through a whole range of emotions from day to day.

"If they're caught in a moment of weakness and have the wrong people around them they could be dead within 72 hours".

Just think about that scenario for a moment. Imagine receiving a phone call out of the blue that the body of your daughter is ready for your collection. Or getting news that your father was killed by a lethal injection because he feared life with prostate cancer.

These scenarios are entirely possible under the Act.

Every week as doctors we see cases where disabled, sick or mentally ill patients will, at their most vulnerable point, contemplate suicide.

With the right care and medicine the vast majority are brought out of this vulnerable state to a place of health. Under the proposed Act, those same people could be dead within 72 hours.

As doctors caring for people who are dying every day we know the difference that this legislation will make to vulnerable people.

It will expose the vulnerable to the extraordinary burden of a duty to die. We are voting no and we invite you to join us in opposing this Act.

• Dr Sinéad Donnelly is a practicing palliative care specialist