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Wednesday, 11 December 2019, 9:13 am
Western Australia’s move to legalise voluntary assisted dying continues a worldwide trend supported by a clear majority of New Zealanders, the End-of-Life Choice Society’s President, Dr Mary Panko, said on Wednesday.
The Western Australian parliament voted Tuesday to join the state of Victoria in allowing terminally ill adults with less than six months to live who are suffering unbearable pain to get medical assistance to end their misery. The law will come into effect after an 18-month implementation period.
It means nearly nine million Australians will join more than 200 million people in Europe and the Americans with enlightened legislation allowing the ultimate human right of the 21st century – the right to die with dignity.
New Zealanders will vote at a referendum next year on whether to approve the End of Life Choice Act passed by 69 to 51 votes in Parliament on November 13. Scientific opinion polls have consistently shown about two-thirds of New Zealand voters are in favour, Dr Panko said.
She said the Western Australian law was similar to that proposed in New Zealand whereby a doctor can prescribe and administer the lethal medication if the patient wishes. In Victoria, patients must take the dose themselves, but Dr Panko said that in all cases, the key word was “voluntary”, only people who were certified to be actually dying would qualify and there were strict safeguards to protect the vulnerable and participating medical staff.
Source: Perth Now
Western Australia has voted to legalise voluntary assisted dying, bringing to an emotional end a lengthy and often heated parliamentary debate.
An emotional Roger Cook (right) has welcomed WA's assisted dying legislation.
MPs exchanged hugs and onlookers in the public gallery burst into applause as the lower house on Tuesday spent more than five hours approving the last of 55 amendments to the government's bill before rising.
WA is the second Australian state after Victoria to legalise voluntary assisted dying, with the scheme expected to be implemented in 18 months.
Health Minister Roger Cook, who oversaw the bill's introduction and was applauded by MPs on both sides for his handling of the process, choked back tears as he welcomed the passing of the legislation.
"We are at the end of a very long process, a momentous process for the West Australian parliament and West Australian public," he told the chamber.
"It's not a time for jubilation.
"Everyone knows what this legislation is about. It's about reflection. And to reflect that we've chosen compassion and the right to choose."
More than 180 hours were spent debating the legislation in parliament, mostly in the upper house where it was heavily amended.
Terminally ill adults in pain and likely to have less than six months to live - or one year if they have a neurodegenerative condition - will be able to take a drug to end their lives if approved by two medical practitioners.
"This is an extraordinary piece of legislation," Mr Cook said.
"Western Australia is not known for its progressiveness in terms of its legislative reform.
"I'd like to think we've come a respectable second (to Victoria)."
The parliamentary debate was often heated, with many MPs critical of Premier Mark McGowan for pressuring the upper house to get on with passing the bill.
MPs were granted a conscience vote and Labor backbencher Adele Farina was among the final dissenters in the upper house.
The premier hailed the passing of the bill as a significant moment for the state.
"Today we showed that at least in Western Australia, we can do big things," Mr McGowan said.
"And in this parliament we have big, compassionate hearts and we're willing to take some political risks to do the right thing.
"For those of you who are worried about your own futures and don't want to die that way ... we thank you for your unwavering support.
"Thank you for your patience. We did it for you."
The NZ Government has released the following information:
This referendum will give the public the opportunity to vote on whether the End of Life Choice Act 2019 should come into force.
The question is:
Do you support the End of Life Choice Act 2019 coming into force?
For consistency, and to ensure that references to the Act are accurate, this website uses the terminology of the Act. But this does not signal a preference for this terminology over any other. There is no Government position for or against the End of Life Choice Act 2019.
Assisted dying. In the End of life Choice Act 2019, this means:
Medication. In the End of Life Choice Act 2019, this means the lethal dose of the medication.
The Act is built on three core elements:
To be eligible for assisted dying, a person must meet ALL of these criteria:
A person will not be eligible for assisted dying because they are suffering from any form of mental disorder or mental illness, have a disability of any kind, or are elderly.
A person is competent to make an informed decision about assisted dying if they can:
A medical practitioner must do their best to ensure that a person's choice to access assisted dying is made of their own free will. The End of Life Choice Act 2019 contains several provisions that seek to ensure this. This includes requiring that the medical practitioner:
If the medical practitioner suspects a person is being pressured about their decision, they must stop the process.
A health practitioner does not have to assist a person with assisted dying if they have a conscientious objection.
The process begins with an initial request from the person to their medical practitioner. A medical practitioner is not allowed to suggest to a person that they consider assisted dying.
Two medical practitioners must agree that the person meets all the criteria for assisted dying and is competent to make the request. If either medical practitioner is unsure of the person's competence, a third opinion from a psychiatrist is required. If a person is ineligible or not competent, the process ends. The person may not access assisted dying.
If the person is eligible and competent, they select a method for receiving the medication, and when they want to receive it.
At the chosen time of administration, their medical practitioner or nurse practitioner must ask the person if they choose to receive the medication. If the person chooses to receive it, the medical practitioner administers it. They must be available to the person until they die. If the person does not want to receive the medication, it must be taken away.
If more than 50% of voters vote 'Yes' in the referendum, the End of life Choice Act 2019 will come into force 12 months after the date the final votes are announced. If more than 50% of voters vote ‘No' in the referendum, the End of life Choice Act 2019 will not come into force and the current law will remain.
End of Life Choice Act 2019's information on the Parliament's website
End of Life Choice Act 2019
Final report of the Justice Committee to Parliament on the End of Life Choice Bill (PDF, 452KB)
As reported in stuff.co.nz 15/11/19 - 'Rest homes struggling to care for patients admitted to die'.
To my knowledge, as a nurse who has practised for the last ten years in aged care at the level of hospital care in a rest home, these facilities are the next option for those with a terminal illness discharged from Hospice or DHB, if care is not available at home.
For many of those whose life has become limited in time and function, hospital-level care at a rest home is where they will have their final days of life.
Hospices and DHB's provide care, inclusive assessment and treatment. When this is completed, the person must seek appropriate accommodation either in their home or in a rest home/hospital environment.
This option is available for the 'next stage' in the process of the end of their life. These facilities are contracted to and paid for in part by the DHB and so care continues.
In the past, I have known circumstances when this care has not been ideal. This is due largely to the nurse who must care for three Palliative patients. At the same time, she also has responsibility for 20-30 other residents. Not forgetting relatives who need reassurance and advice. Close relatives may well be providing hands-on for their loved-ones care, so supplementing what the nurse can do. The nurse has to constantly prioritise her tasks, knowing that she cannot fulfil all that is required of her.
I have been in such a position. It is disheartening when you are working through your shift with a method you have practised many times and you are intent on doing a 'good job'. Your constantly modified 'to do' list does not diminish. Comments are not always complimentary as in the situation of dying, emotions can naturally run high. It is a critical time for those involved and as the nurse, you want to give the best care. The memories of this time are sharp. They are recalled long after the event for all those involved. I want those memories to be great. Not 'All I remember of my mothers' death was the unrelieved pain'.
Years of underfunding have led to this situation. The imbalance of our current situation is obvious. At the present level of funding, there is no better solution.
Source: The Guardian, by Juliet Rix
Giving people control over how and when they die would reduce unavoidable suffering, says the chief of one of the largest hospices in England.
Mark Jarman-Howe: ‘Even the very best palliative care has its limits. That isn’t failure – that’s reality.’ Photograph: Martin Godwin/The Guardian
“We are failing our patients by not engaging openly and honestly with the issue of assisted dying,” says Mark Jarman-Howe, chief executive of St Helena, the largest hospice in the east of England. “We have to end the climate of fear that surrounds discussion of this in the hospice and palliative care sectors, or more than 6,000 people a year will continue to die in avoidable suffering.”
Read more »
In the aftermath of the successful passage of the End of Life Choice bill and its progress toward a national referendum, Maggie Barrie, leader of the bill’s opposition declared, “This means war!” a dramatic and puzzling declaration.
It’s almost axiomatic, that the first casualty of war is the truth. That certainly seems to apply here as the truth about the bill and its aim to provide a legal basis for medically assisted dying for the terminally ill has, in my opinion, been pummeled, sidelined, distorted and ignored by the religious zealots whom I believe Ms. Barry leads and represents. On that basis, Maggie Barry’s cabal has been at war with the New Zealand public since August 6, 2017, the day that David Seymour introduced the bill to Parliament.
While I am a reluctant warrior, these antics have made it my solemn duty to address their fear-mongering, which only hurts the very people they claim to be concerned about, the elderly and the disabled.
What makes this “war” so completely reprehensible is that it is unnecessary. What I mean by that is this. Some opponents of the bill are inspired by their adherence to a religious viewpoint.
That viewpoint would be defensible if it were honestly presented. Then it could be subject to debate. The argument in its simplest terms is this. Life is a gift from God that cannot be returned by the individual, only taken by God—more like a loan. To interrupt its natural course is a sin, thus an offense against God. Some variation of this same theme is present in the religious teachings of Catholics, Protestants, Jews, and Moslems. Variations include the Catholic concept of suffering as virtue endured as Jesus did on the cross.
But these opponents have not presented their case forthrightly, which would start with an open acknowledgment of the religious basis of that opposition which—in instances here -- happens to be Catholic. Instead they have, when pressed, denied such adherence and claimed a bogus concern for the possible misuse of such a bill, if enacted will result in some measure of coercion, forcing death involuntarily upon the susceptible, which they claim are the aged, the infirm and the disabled.
Never mind that the provisions of the bill and its regulatory provisions make such individuals, those primarily with infirmities ineligible. The bill rests upon the competent, autonomous decision of a person with a terminal illness and a life expectancy of six months. The wish for assisted dying must be initiated by the patient, and, while she may be encouraged to discuss this with family and others, the continuing emphasis is on the individual whose consent to the process must be clearly established and be continuous. An eligible person can change their mind at any time before the final acceptance of a lethal prescription.
The EOLC bill is, as its name suggests, about choice. And choice about the time of one’s death and the means for bringing that death about, surrounded as one might wish, by loved ones, and aided by a trusted conscientious medical person, brings a great deal of relief to a terminally ill person who, otherwise, faces the likelihood of a painful ending and an anxiety about the loss of autonomy and of the dignity of ultimate control.
That ultimate empowerment of a terminally ill person recognises a right of an individual to the free exercise of their own judgment about the time and manner of their death, a right consistent with the freedoms granted to those citizens and residents responsible for their own lives.
It’s obvious this view is different than the religiously inspired one. In a democratic society, religious freedom means that religious practice deserves respect and protection but no religion can be permitted to impose its views on those who believe otherwise. In terms of the autonomy and dignity of dying, such imposition of religion determining the manner of death for the non-religious, would be the ultimate coercion.
Source: NZ Herald
Euthanasia campaigner Lecretia Seales' mother says her daughter would have been "over the moon" to see a bill legalising assisted dying finally pass in Parliament.
Shirley Seales was among those in Parliament's public gallery as MPs on Wednesday passed Act leader David Seymour's fiercely debated End of Life Choice Bill 69 votes to 51.
The legislation will now go to a public referendum alongside next year's general election.
Wellington lawyer Lecretia Seales sparked a national conversation about assisted dying in 2015 when she brought a case asking the court to allow her to legally end her life after being diagnosed with a brain tumour.
She died the day after the High Court rejected her case, but inspired Seymour to take up the cause.
Lecretia Seales was a dogged campaigner for the right to end her own life.
After Wednesday's vote, Shirley Seales said her daughter had succeeded.
"If nothing else she wanted to start the conversation and she sure as heck did that," Seales said.
"I'm just so incredibly proud of her. By the time she took her case to court she was so close to dying and it took so much energy for her to actually go through with it, and to appear in court was just unbelievable, especially on the last day.
"She would have been over the moon."
Euthanasia campaigner Lecretia Seales' mother, Shirley, says her daughter was always looking to start the conversation. Photo / Audrey Young
Seales' efforts and case drew attention from many MPs across the house during the debate in the House on Wednesday night, including from Seymour who quoted her in the opening speech.
Afterwards he described Seales as a "martyr in the proper sense of the word" and said her family and lawyers had provided a huge amount of time to the End of Life Choice campaign.
But both he and those fiercely opposed to the legislation are already turning their minds to the referendum, which is expected to cause a ramp-up in already fierce public campaigning.
Historical polling so far has suggested the public would likely back the bill.
A poll in July found there was 72 per cent backing for some kind of assisted dying for the terminally ill among the public. Support over the past 20 years has averaged to about 68 per cent and been consistently positive.
However, the referendum question will ask voters whether they support the End of Life Choice Bill becoming law, rather than assisted dying, and the effect that will have is still unclear.
Since the bill – which would let terminally ill adults request assisted dying – was introduced in 2017, Seymour has devoted the bulk of his time to seeing the legislation through eight protracted parliamentary debates and a record 39,000 submissions from the public.
He says he's optimistic about the next battle.
"Our job is going to be to ensure that we have proper information about how the bill really works, what really happens overseas and on that basis I think the New Zealand people will welcome it," he told reporters after the vote.
But the bill's staunchest critics says they believe the next year will be a chance to turn the public's mind.
"I'm concerned that we've only got one year to inform the public of New Zealand what the bill intends," outgoing National MP Maggie Barry said.
"It's not debate anymore about the issue. It's not about whether you're in favour or euthanasia or not. It's about whether this bill will deliver the end of life choice you want."
The bill is the fourth attempt at legalise assisted dying – starting with one in 1995 – and the only one to clear even a single reading in Parliament.
It's a piece of legislation introduced by Act leader David Seymour that would make it legal for people to request assisted dying, or euthanasia, from doctors, and legal for health practitioners to help people die under certain conditions.
The option would only be open to those who have been diagnosed as terminally ill and with less than six months left to live. It originally also covered people with "grievous and irremediable" conditions, but got narrowed down to get more support in Parliament.
Doctors and nurses are banned from starting conversations about euthanasia under the law, so a patient has to request it themselves.
They would have to go through a series of checks with two doctors, including one appointed through the Ministry of Health.
If the patient meets all the criteria, they get given a form to return, if and when they've picked a time, place and method for how they want to die. They have six months to use it and if they don't, they have to go through the whole process from the start.
Patients can choose whether to have the drugs delivered intravenously, by mouth or tube and whether to trigger it themselves or have a doctor or nurse do it at a place of the patient's choosing, including their home.
Health practitioners are allowed to opt out of participating in any part of the process and the bill states they're not meant to be penalised by their employers for doing so.
Yes. Patients are allowed to change their minds at any point.
Opponents of the legislation have raised a number of issues but the most common has been about coercion.
They say the bill lacks the proper safeguards to protect vulnerable people from pressure to take up assisted dying. They argue it would put subtle pressures on the ill or elderly, particularly if they are made to feel like a burden, and open them up dangers from more overt forms of coercion.
The bill includes clauses saying doctors have to stop the process if they suspect coercion, but critics argue physicians may not know patients well enough or be properly trained to make the call.
All assisted deaths would leave a paper-trail that would be collected by a Ministry of Health-appointed registrar. They would check every death, keep data and report any concerns to medical oversight bodies or even the police.
A public referendum will now be held alongside next year's general election to decide whether the bill should become law.
The bill has been subjected to heated debate in and outside of Parliament for nearly two years and it's expected campaigning will ramp up even further next year.
Many MPs who supported the legislation only begrudgingly backed it going to a referendum because it was the only way to get enough support in Parliament.
Historically, polls have shown there's majority support for some form of assisted dying in New Zealand. But the referendum will ask people whether they specifically support the End of Life Choice Bill and it's not clear what effect that might have.
Justice Minister Andrew Little has said the Government will try to provide objective information to the public ahead of the vote.
Doctors for Assisted Dying Choice (Drs4ADC) http://drs4assisteddyingchoice.org/
Queensland Convenor Group
Dr Sid Finnigan MBBS, FRANZCO
Professor Malcolm Parker MBBS, M Litt, M Hlth & Med Law, MD Dr Heather McNamee MBChB, MRCGP (UK), FRACGP, DFFP Dr Jenny Brown MBChB, MRCP(UK), FRACP
Dr Peta Higgs MBBS, FRANZCOG, CU
Dr Peter Stephenson MBBS (Lon.)
Dr Sid Finnigan E: S&S Finnigan firstname.lastname@example.org PO Box 3218 BIrkdale Q 4159 M: 0402 798 440
We have read the response from the Religious Leaders to the prospect of the legalisation of voluntary assisted dying (VAD) in Queensland. All will agree with their introductory commitments to human dignity and freedom, the importance of Queenslanders feeling valued, and the ability of all to live meaningful, purposeful and fulfilling lives, including through access to high quality health care and end-of-life care. In particular we agree that “Dying well is an important part of what it means to flourish as individuals and communities”.
Nevertheless, we strongly reject the Religious Leaders’ contention that providing assistance in dying is to fail those with terminal illness who are experiencing the level of suffering that would motivate them to request VAD. Below we paraphrase and refute key claims made by the Religious Leaders.
Claim 1. High quality specialist palliative care ensures that no Queenslander need choose VAD in order to avoid a horrible death. All Queenslanders do not have universal access to high quality specialist palliative care, and this should be provided.
The implication is that once everyone has access to high quality palliative care, requests for VAD would cease. There is very good evidence from around the world that this claim is false. Where VAD and high quality palliative care coexist eg in Belgium and Oregon, there is evidence that not all suffering can be avoided and a small but significant percentage of people request VAD. Parliamentary inquiries in Victoria, Western Australia and here in Queensland have all heard medical expert testimony confirming not all suffering can be managed by high quality palliative care. In addition, some terminally ill people do not wish to utilise palliative care, even if it is of high quality. Insisting that everyone would do so is to abridge the freedom that the religious Leaders claim to support.
The implied insistence that VAD should not be legalised until every citizen is assured of access to high quality palliative care is a false, self-serving strategy. While we strongly support increasing access to high quality palliative care, the aspiration to universal access can function as an unattainable goal that remains forever beyond reach. Use of this argument to oppose VAD Legislation is devoid of compassion for those whose suffering is unable to be relieved despite high quality palliative care.
Claim 2. VAD legally enshrines the idea that some human lives are not worth living. This puts vulnerable people at risk of coercion and abuse. People who feel their lives are worthless are particularly vulnerable. VAD undermines the caring for others and being cared for that contributes to our flourishing.
Like many others, the Religious Leaders conflate the ideas of feeling worthless and feeling that one’s life is no longer worth living. Just like those who request that life-sustaining treatment be withdrawn or who refuse further active treatment (lawful requests), people who request VAD do not feel worthless. The Religious Leaders fail to acknowledge or perhaps simply don’t understand that rational terminally ill people have heightened insight into the value of their life and are certainly capable of determining for themselves if their symptoms and quality of life are no longer adequately managed. In the setting of terminal illness with irremediable suffering, the feeling that your life is no longer worth living and the feeling that you are a very worthy and valued person, are, in fact, perfectly compatible states of mind.
There is no evidence from jurisdictions that have legalised VAD that people who consider that their lives are no longer worth living – in either of the two groups described above – have been either vulnerable or subjected to abuse.
People who choose VAD where it is lawful, and their families and friends, would strongly deny that the availability and the process of VAD undermines the flourishing that comes from caring and being cared for. They would insist on the opposite – that provision of VAD in their case constitutes being cared for in a way that they place great value in. For the Religious Leaders to claim otherwise is to project their own particular view of flourishing on to those who do not share it.
Claim 3. VAD undermines human freedom because it seems to offer the misleading choice of dying a horrible death or taking your own life.
This choice currently operates, even in the setting of high quality palliative care. In Queensland between 2106 and 2017, 168 terminally ill people died as a result of self harm. VAD would offer terminally ill people a choice to peacefully end their lives if they wish rather than being forced to choose a painful or violent and lonely death. What is misleading is the Religious Leaders’ willingness to omit mention of palliative care when they believe it suits their argument. Supporters of VAD are on record as being consistent supporters of the provision of high quality palliative care, improving access to palliative care, and ensuring that people are aware of all end-of-life choices.
Claim 4. VAD undermines efforts to address the crisis of suicide in Queensland. We should not affirm the idea that some lives are not worth living.
Aside from repeating the error of VAD affirming the idea that some lives are not worth living, the claim about suicide is false. There is no evidence that suicide rates have increased in jurisdictions that have legalised VAD. Nor is there any evidence that in these jurisdictions, efforts to address the problem of suicide (other than lawful assisted suicide) have been weakened.
Sid Finnigan is a recently retired Ophthalmic Surgeon with subspecialty interest in Ocular Oncology, having previously spent four years in Queensland Country Hospital Service followed by ten years in General Practice prior to specialist ophthalmic training.
Malcolm Parker is Emeritus Professor of Medical Ethics at the UQ and Adjunct Professor at the Australian Centre for Health Law Research at QUT. He was in general medical practice for over thirty years. He has published widely in medical education, philosophy of medicine, medical ethics and law and bioethics, including end-of-life ethics and law.
Heather McNamee is a GP in regional Queensland with special interests in reproductive health, adolescent and HIV medicine and telehealth. She has prior experience in paediatrics including paediatric oncology.
Jenny Brown is a specialist physician in internal medicine with over 30 years’ experience. She set up the palliative care service at Mater Health Services Brisbane, where she was Director of Medicine and Chief of Medical Staff. Dr Brown was previously Clinical Associate Professor of Medicine at UQ, training many medical students and junior staff, and was an examiner for the Royal Australasian College of Physicians.
Peta Higgs is a Subspecialist Urogynaecologist in private and public practice on the Sunshine Coast. She is the immediate past Chair of the Urogynaecology Subcommittee for RANZCOG and an examiner in Urogynaecology.
Peter Stephenson has been a family doctor since 1977 in the Moreton Bay Region,
Parliament has passed a fiercely debated bill legalising assisted dying, with the public to now make the final decision on the legislation next year.
The End of Life Choice Bill passed 69 votes to 51 at its third and final vote in the House on Wednesday night and will now to go to referendum alongside the 2020 general election.
So how would assisted dying work and what happens now?
The option would be open to those who have been diagnosed as terminally ill and with less than six months left to live. It originally also covered people with "grievous and irremediable" conditions, but got narrowed down to get more support in Parliament.
Patients can choose whether to have the drugs delivered intravenously, by mouth or tube and whether to trigger it themselves or have a doctor or nurse do it at a place of the patient's choosing, including at home.
Health practitioners are allowed to opt out of participating in any part of the process and the bill states they're not meant to penalised by their employers for doing so.
Opponents of the legislation have raised several issues but the most common has been about coercion.
Many MPs who supported the legislation only grudgingly backed it going to a referendum because it was the only way to get enough support in Parliament.
Historically, polls have showed there's majority support for some form of assisted dying in New Zealand. But the referendum will ask people whether they specifically support the End of Life Choice Bill and it's not clear what effect that might have.
The Minister of Justice has plans in place to combat misinformation and manipulation in any campaigns leading up to, potentially, two divisive referendums at next year's election.
Justice Minister Andrew Little Photo: RNZ / Rebekah Parsons-King
That includes a special team within the Ministry of Justice to direct people to information aimed to be as accurate and neutral as possible, and to be on the look-out for any attempts to deliberately mislead the public.
It's the first time core public servants have taken on this role, and they'll have to walk a tightrope between providing credible public information and getting drawn into any partisan debates.
Voters will not only have to choose the government come 2020, but will also have their say on legalising recreational cannabis, and potentially, voluntary euthanasia.
The latter still has to pass its final reading on 13 November. If it does the referendum will be held.
Minister of Justice Andrew Little said the Electoral Commission would look after the nuts and bolts of running the referendums, whereas the justice team would manage the public information, websites, and respond to public queries.
The team would also have a monitoring role, he said.
"That if someone claims to have a highly authoritative piece of research - it is that, not some sort of highly partisan, highly sceptical or dubious piece of information," Mr Little said.
The Electoral Commission would also keep watch so people did not go "so far wide of the mark" that it crossed over into "misinformation".
The debate was prone to "fairly emotional and irrational responses" but should focus on "real facts, real issues" and in the end the electorate would make its choice, Mr Little said.
Officials operate under strict public sector rules that require them to be politically neutral and non-partisan.
Nick Smith. Photo: RNZ / Alexander Robertson
National MP Nick Smith questioned the ability of justice officials to be able to stay within those rules, saying for the most part the government wanted voluntary euthanasia to become law.
"It's really inappropriate for the justice ministry to have this role ... when the Cabinet manual and the State Services Commission is very clear they are there to follow the instructions of the minister and deliver government policy."
Mr Little acknowledged it would be "a very difficult balancing act" for public servants to avoid being seen as pushing one side or the other or being drawn into the debate.
"I think they are very alert to that, I think we have a very good culture in our state sector ... those in this unit in justice providing this oversight are totally aware of how they may be drawn in to answering questions and queries - I'm totally confident they will discharge their public service responsibilities with great care," he said.
The sponsor of the End of Life Choice Bill, ACT leader David Seymour, put his trust in the "wisdom of crowds" to identify misinformation or manipulation when they saw it.
"A massive information campaign, or should I say misinformation campaign, has failed to shift public opinion."
Part of that was many people based their views on personal experience, said Mr Seymour.
"They've seen bad death, and they've said 'when my time comes that's not for me, I want choice' ... it's very difficult to overturn people's heartfelt feelings with Facebook advertising."
Vocal opponent and National MP Maggie Barry said she was still hopeful the Bill would fail its third reading, as many MPs still held concerns about the lack of safeguards.
If the referendum did go ahead, she and others with similar views would continue to point out what they saw as the "dangers of the Bill and its flaws" so people could make an informed decision.
She hoped any election year debate would be conducted in a "civilised way".
An MP's job was to stand up for what they believed, but also to act with sensitivity, Ms Barry said.
"And I don't think either side has exactly covered itself with glory, upon occasion, but that said it's important everyone realises how important this issue is and we get a formula whereby the public can have as thorough as view of this legislation as possible."
But Dr Smith said the name of the legislation was in itself a form of misinformation.
"The 'End of Life' phrase makes it more acceptable to pass ... 'choice' has got a nice, fuzzy feel about it but if you talk about, actually, providing injections of poisons to kill people, you get a very different response."
Mr Little said government websites would feature what he described as "independently prepared information relevant to the issues".
Part of the advertising and marketing campaign would be directing people to those sites.
The government would be "looking out carefully" for signs social media or other platforms were being used to mislead people as had happened in political campaigns overseas, Mr Little said.
"There will be some things claimed in each case that will be highly questionable and and it's a question that in the course of the debate that stuff gets called out, and we do our best to keep the debate clean."
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