End of Life Choice Act Advertisments

Right to Life New Zealand’s Newspaper Advertisments End of Life Choice Act Referendum

The Christchurch Press and The Dominion Post Saturday 10th October 2020 and Sunday Star Times on Sunday 11th October 2020

Is the End of Life Choice Act what you think it is?

Would euthanasia only be a last resort?

Many Kiwis want a euthanasia law only for people who are in severe pain and who have no other options left. But we are voting on a very different law:

A person can request euthanasia on the same day they are diagnosed. Section 11(1) of the Act allows anyone to make a request for a lethal dose. There’s no requirement to wait after being diagnosed with a terminal illness. There’s also no requirement to meet all the eligibility criteria before expressing such a wish. After making a request and confirming it in writing, the person’s eligibility would be assessed. Some would meet the criteria and some would not (section 16).
An eligible person can receive it even if they don’t have any physical pain.
Section 5 of the Act lists the eligibility criteria. One of these is the requirement to “experience unbearable suffering that cannot be relived in a manner the person considers tolerable” (section 5(1)(e)). The Act does not define “unbearable suffering” and doesn’t state that it has to be physical. The word “pain” is not mentioned.
The doctor has to tell the person about their end-of-life care options, but the person doesn’t have to try any of these before receiving the lethal dose.
The Act requires the first doctor to “ensure that the person understands their other options for end-of-life care” (section 11(2)(b)). However, the Act does not require the person to try any of these options before requesting a lethal dose or after the doctor has explained their options to them.

Would the safeguards be enough?

Many Kiwis want a euthanasia law only if it has very good safeguards to protect vulnerable people. Safeguards are needed to protect people from dying because they were pressured to request it, or because they made a hasty, emotional decision.

We are concerned that the End of Life Choice Act would not protect all vulnerable people because:

No witnesses are required to check whether a person is being pressured when signing their request in front of the doctor. (Unlike the assisted dying laws of Canada, Victoria Australia (Vic), Western Australia (WA), and the 9 USA states where it’s legal)
The End of Life Choice Act does not require any witnesses to be present when the person confirms their request in writing (section 12).Each of the following overseas laws require two witnesses to be present when the person signs their written request. The doctor cannot be one of the witnesses.

Canada: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (S.C. 2016, c.3). Section 241.2(3)(c), Section 241.2(5)(c).
Victoria, Australia: Voluntary Assisted Dying Act 2017, section 34(2)(b).
Western Australia: Voluntary Assisted Dying Act 2019, section 42(b), section 43.
California, USA: End of Life Option Act. Section 443.3(b)(3).
Colorado, USA: Colorado End-of-Life Option Act. Section 25-48-104 (2)
District of Columbia, USA: Death with Dignity Act of 2016. Section 3(2)(b).
Hawaii, USA: Our Care, Our Choice Act. Chapter 3.
Maine, USA: Maine Death with Dignity Act. Section 2140(5).
New Jersey, USA: Medical Aid in Dying for the Terminally Ill Act. Section C.26:16-5.
Oregon, USA: Oregon Revised Statute: Oregon’s Death with Dignity Act, section 2.02.
Vermont, USA: Patient Choice and Control at End of Life Act (Act 39). Section 5283 (a)(4).
Washington, USA: The Washington Death with Dignity Act. Section RCW 70.245.030.

An eligible person could receive euthanasia as early as 4 working days after requesting it. (See par. 271, tiny.cc/mohmoj)
Ministry of Justice and Ministry of Health, Departmental Report on the End of Life Choice Bill, paragraph 271, page 46.

Would the safeguards be enough?

There is no required cooling-off period before the lethal dose is prescribed. (Unlike Canada, the 9 US states, Vic & WA)

The End of Life Choice Act does not mention any required time-frame between making a request (section 11) and the prescription of the lethal dose (section 19). The only timeframe mentioned is a minimum of 48 hours after the prescription is written (section 19(3)).

Canada: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (S.C. 2016, c.3). Section 241.2(3)(g).
California, USA: End of Life Option Act. Section 443.3(a).
Colorado, USA: Colorado End-of-Life Option Act. Section 25-48-104 (1).
District of Columbia, USA: Death with Dignity Act of 2016. Section 3(a)(1).
Hawaii, USA: Our Care, Our Choice Act. Chapter 2 (1).
Maine, USA: Maine Death with Dignity Act. Section 2140(13).
New Jersey, USA: Medical Aid in Dying for the Terminally Ill Act. Section C.26:16-9 (10)(5).
Oregon, USA: Oregon Revised Statute: Oregon’s Death with Dignity Act, section 3.06.
Vermont, USA: Patient Choice and Control at End of Life Act (Act 39). Section 5283 (a)(2).
Washington, USA: The Washington Death with Dignity Act. Section RCW 70.245.090.
Victoria, Australia: Voluntary Assisted Dying Act 2017, section 38.
Western Australia: Voluntary Assisted Dying Act 2019, section 48(1).

No witness is required when the doctor or nurse practitioner gives the lethal dose to the person. (Unlike Vic & WA)
Section 20 of the End of Life Choice Act is about the administration of medication and does not mention a witness.

Victoria, Australia: Voluntary Assisted Dying Act 2017, section 46(c).
Western Australia: Voluntary Assisted Dying Act 2019, section 59(5).

No mental competency confirmation is required when a person receives the lethal dose. (Unlike Canada, Vic & WA)
Section 20 of the End of Life Choice Act is about the administration of the lethal dose of medication. It does not mention mental competency or capacity. The attending medical practitioner or nurse practitioner needs to ask the person whether the person still wants to receive it at that time, but the health professional does not need to confirm that the person is competent at that time.Canada: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) (S.C. 2016, c.3). Section 241.2(3)(g)-(h).
Victoria, Australia: Voluntary Assisted Dying Act 2017, section 46(c)(ii).
Western Australia: Voluntary Assisted Dying Act 2019, section 59(5)(a).
The doctor doesn’t need to have met the person before, which makes it difficult to know whether the person was pressured.
Section 11 of the Act does not require that the doctor knows the person for a certain period of time before a request could be made to them. If the doctor who receives a request has a conscientious objection, a replacement medical practitioner would be nominated (section 9). There is no requirement that this replacement doctor needs to have met the person before receiving the request.
The NZ Act says one doctor must “do their best to ensure the person expresses their wish free from pressure from any other person”. The doctor needs to do this only by speaking to health professionals and to family members approved by the person.

Section 11(2)(h) of the Act

A person does not have to tell any loved ones about their decision and can refuse permission for the doctor to speak to family.
Section 11(2)(f) of the Act states that the doctor must “ensure that the person knows that they are not obliged to discuss their wish with anyone”. Section 11(2)(h)(ii) requires the doctor to confer only “with members of the person’s family approved by the person”.
If the doctor suspects pressure, they must stop the process, but elder abuse often remains undetected.
The attending medical practitioner and the nurse practitioner are required to stop the process if they suspect pressure (section 24). The independent medial practitioner (section 14) and psychiatrist (section 15) are not required to check for pressure or to stop the process if pressure is suspected.Age Concern reports that elder abuse is often covered up and that “much abuse is unreported to agencies”.
There is no required psychological assessment or screening for depression.

The attending medical practitioner (section 11, section 13); the independent medical practitioner (section 14); and the psychiatrist (section 15); need to check whether the person is competent to make an informed decision. However, competency does not include freedom from depression (section 6). The Act does not require any of these medical professionals to do a psychological assessment.

Competency should be assumed, unless there are reasonable grounds for believing that the person is not competent (Code of Health and Disability Services Consumers’ Rights, Right 7(2)). If the person is competent. The medical professional would not need to investigate the person’s mental health at all. This means that many, if not most, applicants would not receive any psychological assessment.

A person cannot be eligible if their only ground is mental illness. However, a person will be eligible if they have a mental illness, a terminal illness and meet the other eligibility criteria (section 5(2)).

The Christchurch Press and The Dominion Post Saturday 26th September