Why End of Life Choice
Why I prepared this Bill – David Seymour MP
The issue of assisted dying is one I considered for some time before drafting the End of Life Choice Bill, which is currently being reviewed by the Justice Select Committee, and I want to explain here why I introduced this Bill to Parliament.
The primary motivation for this Bill is compassion.
Many of my constituents urged me to proceed with a Bill, particularly in light of the withdrawal in 2014 of a similar Bill sponsored by Iain Lees-Galloway, originally introduced by former MP Maryan Street. Two previous Bills on this issue have in the past failed to gain Parliamentary support, but the clear international trend since the 1990s is towards the legalisation of medically assisted end of life choice.
The motivation for this Bill is the very real anguish faced by people with terminal illness, as they anticipate the prospect of intolerable suffering, and the indignity of the final few days and weeks of their lives. While pain can be ameliorated somewhat, the suffering and indignity of that final period of life remains a profound concern to many people.
The intention of the Bill is to allow people with a “grievous and irremediable medical condition” to obtain medical aid to die if they should so choose.
I appreciate that within our community there is a wide range of religious and philosophical views which influence attitudes to this issue. What is unthinkable for some, is considered by others the most compassionate way to address the inevitability of end of life, and the realities of terminal illness.
The Bill offers choice that is currently prohibited, for those in our community who are grievously and irremediably ill and who wish to have the option, as they near life’s end, to choose the manner and timing of their final days.
There are several key considerations behind my private member's Bill.
In my view it is politically, morally, legally and, in terms of public policy, the right thing to do.
I will consider each of these in turn.
Legally this is the right thing to do.
As noted in the 2015 judgement on the Lecretia Seales case, the issue of end of life choice is a matter for Parliament to determine.
Likewise, in 2015 the Canadian Supreme Court determined unanimously that "The prohibition on physician-assisted dying infringes on the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice."
But the Court suspended its judgement for 12 months, giving the Canadian Parliament a year to draft new legislation to reflect that judgement.
This reflected a view that it is a matter for Parliament to decide, not the Courts. Legislation to give effect to assisted dying involves very many detailed ethical, legal and practical considerations.
The scrutiny of a select committee process, examining a concrete proposal, is the best and most thorough way of considering this issue.
In terms of appropriate legal process, introducing a Bill to Parliament was the right thing to do.
Morally this is the right thing to do.
The difficulty with assisted dying is that we are attempting to balance competing values, each of great importance.
The first is the sanctity of life and the need to protect the vulnerable. The second is the autonomy and dignity of a competent adult who seeks to end their life as a response to a grievous and irremediable medical condition.
The difficulty is that an absolute prohibition on assistance in dying effectively creates a “duty to live” rather than a “right to life”.
An absolute prohibition on assisted dying also calls into question the existing legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment. Yet already there is a degree of societal consensus that the administration of palliative sedation and the withholding or withdrawal of lifesaving or life-sustaining medical treatment, which can have the effect of hastening death, are ethically acceptable.
Protracted dying was once rare; death typically came swiftly. But medicine has advanced, and now a protracted death is common.
By acknowledging this reality, the argument can be advanced that it is also ethical for voluntary adults who are competent, informed, grievously and irremediably ill, and where the assistance is clearly consistent with the patient’s wishes and best interests, and in order to relieve suffering, for them to have the option of physician assisted end of life.
In short, an absolute ban on assisting another person to end their own life can amount to condemning a person to a life of severe and intolerable suffering.
It was for that reason the Canadian Courts concluded that the ban on assisted dying was too broad – by justifiably attempting to protect the vulnerable, it denied the rights of some individuals in a way that bore no relation to the object of the law.
As the Court said, “A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”
That is why the international trend since the 1990s has been for Parliaments to recognise that, in certain well defined circumstances, an individual’s choice about the end of their life is entitled to respect.
The international evidence was closely examined in the Canadian courts. There it was stated that an absolute prohibition on assisted dying would have been necessary if:
- The evidence showed that physicians were unable to reliably assess competence, voluntariness, and non-ambivalence in patients;
- That physicians fail to understand or apply the informed consent requirement for medical treatment;
- Or if the evidence from permissive jurisdictions showed abuse of patients, carelessness, callousness, or a slippery slope leading to the casual termination of life.
But after an exhaustive examination of the evidence these possibilities were rejected. The judgement found that properly designed and administered safeguards were capable of protecting vulnerable people from abuse and error, that the elderly or people with disabilities are not at a heightened risk, and that there was no evidence of a slippery slope.
Morally, reconsidering the law on end of life choice is the right thing to do.
Politically this is the right thing to do.
My job as a Parliamentarian is to represent the voters, and that involves reflecting the will of the public, insofar as that “will” makes sense and is not inconsistent with my fundamental beliefs.
On this issue, for some MPs, there will inevitably be a clash with some profoundly important religious or philosophical beliefs.
That said, the public clearly wish this issue to be debated, so that regardless of one’s personal view on the matter, this is an issue which deserves to be placed before Parliament and which deserves also to be taken to the public in the form of a referendum.
Advancing the End of Life Choice Bill through a thorough examination at select committee, and committee of the whole House is the best way to respond to the wishes of the NZ people.
I concluded therefore that, politically, introducing my Bill was the right thing to do.
In terms of public policy this is the right thing to do.
The law against assisting somebody to end their life, is of course a ‘generally sound law’. But it is also one which has an extraordinarily harmful effect on a small number of individuals.
As the Canadian judgement determined, that law is overly broad.
As a matter of public policy, we need to reconsider the situation of that small number of persons who:
- clearly consent to the termination of their life, and
- have a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual.
My case is that New Zealand needs and - as is evident from recent opinion polls - wants this debate.
Our Parliament should facilitate this discussion by considering this issue through the mechanism of the End of Life Choice Bill passing its second reading in the House and proceeding to committee of the whole House.
All New Zealanders should have the opportunity to be heard on this matter.
The End of Life Choice Bill allows this much needed review of our laws to occur.
It is the right thing to do.