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  • 21 Sep 2020 9:48 AM | Philip Patston (Administrator)

    Source: Southland Times

    Euthanasia referendum: New Zealanders will vote on the End of Life Choice Act during the general election.

    OPINION: What is the value of suffering and to whom is it of value?

    Euthanasia referendum: New Zealanders will vote on the End of Life Choice Act during the general election.

    What can you do when you have just had enough?

    Who else’s business is this anyway?

    These are the questions to be pondered in the upcoming referendum on euthanasia.

    I am now 78. I graduated from Otago University in 1965 and have spent my working life in family medicine. I have attended well over a thousand births and many deaths as a family doctor.

    In addition, I have been a DHB elected member in Nelson-Marlborough for 12 years and worked with councils and community and sporting organisations.

    I have had simple heart surgery and have prostate cancer. Not surprising at all at my age.

    Dr John Moore.

    Supplied/Stuff

    Dr John Moore.

    Death to me is expected and well prepared for – I have done my best in this regard. Life remains busy, active and lots of fun.

    In our lives there is only one certainty. Life will end.

    This fact is often not acknowledged in family conversations; indeed, the reverse is often the case and a culture of denial is fostered.

    Death becomes a failure of treatment or somehow avoidable.

    This unspeakability extends to the person doing the dying and often those giving professional advice. As a result, death becomes greatly feared instead of normalised.

    The fear makes avoidance of the subject even worse.

    Sadly, because of this, it is far from uncommon to find that families argue over treatment options for a parent who is unable to express their own wishes. Enduring emotional conflicts between siblings can result.

    I guess I am just saying that we often do death badly in this country.

    There can be poor communication, needless suffering and often much futile and expensive treatment. Families must be open to listening to personal wishes and expectations.

    To live well and die well seems a reasonable aim for existence

    In NZ now we have a facility called Advance Care Planning which is a tool for leading discussion and individual decisions around dying and very serious illness. We have excellent hospices and palliative care systems too.

    What we lack is the ability to make our own choice about when we have just had enough and want to go.

    We can be obstructed by others who believe that they know what is best for us.

    (The law at present allows us to suicide alone and unassisted – anyone present is criminally liable – but not to die by choice with care, dignity and with those we love around us.)

    I always come back to this point: who else should have the right to impose their beliefs on my decision?

    The End of Life Choice Act gives you and me some choice in the matter. Though still quite constrained, it is a step towards personal choice.

    Studies overseas consistently show that what most people want is the right to say enough. They want control.

    Knowing that this right of control exists provides much comfort whether it is used or not.

    Those who feel duty bound to endure and suffer to the very end already have that right.

    My life is my story and I should be allowed to write it myself. The same goes for you.

    Dr John Moore was the first GP in Te Anau, 1968-1976, a leading figure in the Save Manapouri campaign and one of the original Guardians of Lakes Manapouri, Monowai and Te Anau. He now lives in Nelson.


  • 19 Sep 2020 12:28 PM | Philip Patston (Administrator)

    IMG_9426.jpgRowan Stephens is a retired GP. She practiced in the UK and NZ for 26 years.

    I am a retired GP, I will be voting a resounding YES in the EOLC Act Referendum.

    Over a lifetime of practice, I have seen many patients die. I am haunted by the knowledge that I have abrogated my responsibility to a small number of my patients.

    I was prevented by law from fully easing their requests to end their unbearable suffering, 

    ‘Be there at the end and help me die.’

    ‘Please give me some dignity in death’.

    ‘Put me out of my misery, you wouldn’t let your pet suffer like this’

    I failed in my duty of care because of the existing law. People who trusted me and looked to me for help, for skill and compassion at the end of their lives, looked in vain. I was prevented from giving them what they needed and begged for, compassion, choice, the certainty that their inevitable death could be peaceful and dignified.

    ‘Primum non nocere’ encourages us to consider the consequences, the possible harm, of what we do and what we do not do, every intervention or omission and how they may cause harm, especially in the complex circumstances that often surround dying. Failing to provide assisted dying to those who request it and who meet the strict legal and medical criteria of this Act, does significant harm. 

    I trust my fellow colleagues to implement this law to the best of their ability, the EOLC Act will be a safe move towards better deaths. 

    International and New Zealand evidence

    The latest and largest international review concluded from 20 years of data that that assisted dying is safe.1 Data demonstrate that no ‘vulnerable’ groups are overrepresented in those who access assisted dying in Oregon and the Netherlands,2 or Belgium.3 Oregon’s Act, which the EOLC Act is based on (plus adopting several safeguards from the Victorian legislation), has remained a strict piece of law. 

    Australian data tells us that 2-5% people, suffer unbearably as they die, in spite of excellent Hospice/Palliative Care (H/PC).4 This translates to at least 225-250 Kiwis, every year. Additionally, the Coroner’s office attributes 52 deaths/year, about one death per week to terminally ill, mentally competent Kiwis, ending their lives to end their suffering.5, 6 They have no kinder alternative. They deserve legal autonomy, to have choice about how, when, where and with whom.

    Out of compassion for this suffering, research shows that doctors are already carrying out assisted dying. Over 5% of NZ GPs who responded to an international standardised survey admit they are intentionally hastening death regardless of the legality, and not always with patients’ consent.7, 8 It is safer for us and our patients to bring the practice of hastening death out into the open so doctors who are willing to participate can be protected under strict regulations and patients can give informed consent. 

    Research shows 45% of GPs and 37% of doctors support choice for the terminally ill.9 This number will grow with legalisation as we feel more comfortable discussing what has felt like a taboo topic within medicine for too long.


    The gift of comfort

    Dr. David Grube, from Oregon, is a deeply compassionate GP and H/PC Physician with 22 years of experience of working with Physician Assisted Dying. Dr Grube recognises the comfort patients and families feel when they are able to discuss such choices, palliation in itself.  He describes the “gift’ of a good death for patients and their loved ones and describes this process as an intrinsic part of end of life care. In Oregon almost 90% of patients who access their law, are already receiving H/PC and are estimated to only shorten their lives by 10 days, not long in the context of a whole life, but an eternity if you are suffering unbearably. Of those who qualify, about one quarter, do not need to use it, they talk movingly of the relief of knowing that they can.  

    A ‘yes’ vote is the compassionate choice

    When my patients were dying, I wanted to be able to care for them in the way they choose. Dying patients deserve the benefit of our skill and experience in providing expert symptom control, emotional support for the patient and their family, and much needed reassurance through the challenges of a terminal illness, with the input of hospice as required. We know that our patients ought to have autonomy and choice over their lives. To emphasise patient self-determination and patient-centreredness and then refuse to honour it is inconsistent. 

    Voting yes in the referendum will give Kiwis of sound mind, over 18, dying, with less than 6 months to live and irremediable suffering, the choice I have been unable to give some of my patients, the hope that they may die in peace and dignity. Voting yes is my way of facilitating the gift of a Good Death to patients who need it.


    1.Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, et al. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Journal of the American Medical Association. 2016;316(1):79-90.

    2.Battin MP, van der Heide A, Ganzini L, et al. Legal physician‐assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics. 2007;33(10):591-7.

    3.Chambaere K, Bilsen J, Cohen J, et al. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal. 2010;182(9):895.

    4.Australian Palliative Care Outcomes Collaboration. Patient outcomes in Palliative Care National report July to December 2019. https://documents.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow264401.pdf; 2020.

    5.Weaver JC. Sorrows of a Century Interpreting Suicide in New Zealand, 1900-2000. Wellington: Bridget Williams Books; 2014.

    6.Cheung G, Douwes G, Sundram F. Late-life suicide in terminal cancer: A rational act or underdiagnosed depression? Journal of Pain and Symptom Management. 2017;54(6):835-42.

    7.Malpas PJ, Mitchell K, Koschwanez H. End-of-life medical decision making in general practice in New Zealand-13 years on. The New Zealand medical journal. 2015;128(1418):27.

    8.Mitchell K, Owens RG. End of life decision-making by New Zealand general practitioners: A national survey. The New Zealand medical journal. 2004;117(1196):U934.

    9.Young J, Egan R, Walker S, et al. The euthanasia debate: Synthesising the evidence on New Zealander's attitudes. Kōtuitui: New Zealand Journal of Social Sciences Online. 2019;14(1):1-21.


  • 07 Sep 2020 5:02 PM | Philip Patston (Administrator)

    Source: Stuff

    During his 36 years as a Presbyterian minister, Craig Kilgour spent many days dealing with death, dying and funerals.


    He has witnessed what he believes was unnecessary suffering. He has also seen a loved one permitted to “die with dignity” surrounded by family, through assisted dying, when they decided it was time to go.

    Read more »

  • 07 Sep 2020 9:18 AM | Philip Patston (Administrator)

    Source: Newshub

    "It's not good news, Stu."

    Those were the words Stuart Armstrong's GP, a long-time friend who had delivered his daughter, spoke through tears in May 2014 as she confirmed the worst - his illness was incurable.


    Read more »

  • 04 Sep 2020 10:09 AM | Philip Patston (Administrator)

    Source: NZ Herald

    Last year, after more than two years of scrutiny, the End of Life Choice Act was passed into law. By the third reading, our elected lawmakers were confident the final wording was safe, humane, and well-drafted. With National's recent leadership changes, all of our party leaders from the last Parliament now support this Act.

    As a result, New Zealanders should feel very confident voting Yes at the referendum. And yet, it has been frustrating to see attempts to chip away at that confidence through fear, uncertainty and doubt.

    Australian journalist Andrew Denton wrote about attending an international conference hosted by HOPE, an anti-assisted dying organisation. He listened to former legislator Nancy Elliott spell out the tactics that had worked for her in the United States. "

    When you have lots of arguments," she said, "if one argument gets blown out of the water, you still have more, and each argument will reach somebody else." Nancy enthused: "Right now the disability argument is really kicking it. It's very powerful. Will it always be powerful? We don't know. Two, three, four years from now that may have holes kicked in it, just for different reasons, so we have to be flexible."

    She also cited elder abuse and suicide contagion as possible arguments, and went on to say: "You only have to convince legislators that they don't want this bill. You don't have to win their hearts and minds; all you have to do is get them to say, Not this and then you have got your win."

    Opponents of the End of Life Choice Bill tried to use these tactics on our politicians in New Zealand. They claimed the Bill would be a slippery slope, invite elder abuse and devalue the lives of the disabled. But our politicians looked past these speculations to the evidence — 20 years of history in some countries — and to the wording of the bill. MPs were satisfied that the evidence, reasserted in Seales v Attorney General, showed:

    The majority who access these laws overseas are dying of cancer, and in the last weeks, even days of their lives; the groups most in need of protection from abuse under these laws — the elderly and the disabled — have faced no increased risk overseas; and these laws have not adversely affected the relationship between patients and doctors, in fact, the opposite; there is a powerful palliative effect in simply giving people the means of ending the horror. Some sense of control, even if they choose not to use it.

    None of these facts have changed. But now, we're seeing opponents attempt to use fear, uncertainty and doubt on the New Zealand public in the lead-up to the referendum. Whether it's the self-published "journalist", who claims to be objective but structured a book primarily made up of opponents to Lecretia's court case in order to advance her arguments, who claimed to interview Lecretia's mother, but never did, and has appeared to have duped naive journalists that she provides an objective voice.

    Whether it's Votesafe, who cherry-pick details of the bill and present them in the worst possible light to scare voters. Or whether it's the often-church-backed doctors and lawyers who falsely claim to speak for all in their profession, but use their platform to advance an agenda to deny their patient's rights to make informed decisions for themselves.

    Voters need unbiased information, and deserve to know the agenda of the people who are seeking to provide information on either side of the debate.

    We provide information to the public through our Yes for Compassion campaign, but we're not shy about our agenda or who we are. We're ordinary New Zealanders who have lost family and friends to terminal illness, or who are terminally ill ourselves, who can see how this law would be a comfort. We want New Zealanders to vote Yes.

    If anyone took the time to compare Yes for Compassion's campaign with the information on the government's referendum website, they'd find it's basically the same information. There's a reason for that. We don't need to deviate from the truth.

    The bill provides a way for terminally ill people, in the last days of their lives, to foreshorten their suffering should they need it, and should they choose to. That's all it does. I hope you never find yourself in that situation. But if you do, I hope you have the choices that my wife was denied. Please vote Yes in October.

    Matt Vickers is the former husband of Lecretia Seales and a spokesman for Yes for Compassion.


  • 02 Sep 2020 8:43 AM | Philip Patston (Administrator)

    Source: RNZ

    This story discusses assisted dying and suicide, and could be distressing for some readers.

    A woman whose terminally-ill husband chose suicide over a prolonged painful death is urging New Zealanders to allow people the option to die with dignity.


    The public will be asked to vote yes or no to the End of Life Choice Act 2019, at this year's 17 October referendum on the day of the national election.

    *See all RNZ coverage of the Euthanasia Referendum 2020

    Explainer here

    The act would allow terminally ill people who are given six months or less to live and who are experiencing unbearable suffering the option of medically assisted dying.

    Richard, Heather Gregory's husband of 30 years and father to their five children, was diagnosed with carcinoid cancer at 58 years old.

    He had lived with the slow-growing cancer for years, but in 2014 his health rapidly declined.

    "The tumour exudes hormones, and it damaged his heart. He wasn't getting enough oxygen, his body was breaking down," Heather said.

    Heather Gregory, with a wedding photo showing her late husband Richard.

    Heather Gregory, with a wedding photo showing her late husband Richard. Photo: RNZ/ Anusha Bradley

    "When it happened, it was very sudden and very severe."

    She said Richard was thin and she had to dress his weeping leg wounds in adult nappies every day. He had a bed sore on his back, and his personality had changed.

    "He felt he was losing control. The day he died, he had a nap in the sun and when he went to push himself up, he couldn't, he wasn't strong enough."

    On that August night in 2014, Heather went off to her quiz night in her home town of Hastings.

    But she had bad feeling she couldn't shake. She contacted her daughter at 8.30pm, and that's when she heard the news.

    Heather Gregory, with her family before the death of husband Richard.

    Heather Gregory with her family before the death of husband Richard. Photo: RNZ

    Richard had taken his own life.

    The fallout from Richard's suicide was distressing. Two of their adult children were left traumatised after finding him, and the three who weren't there felt displaced, Heather said.

    "It was a devastating end to a very good life, and it could have been so much better."

    She said she had not prepared for it. It was not the ending she and their five children had hoped for.

    "We got the double whammy - the long ending and then the sudden death. I thought we would be sitting around a bed talking about things."

    Richard's suffering was unbearable and there was little that could truly relieve it, Heather said.

    Had euthanasia been an option, he would have taken it, she said.

    "If this had been in place it would have changed the whole dynamics of the whole situation leading up to it, and the final moments, and the time afterwards."

    "There's nothing like a plan, is there, to put yourself at ease."

    The public has a very medically assisted life, and that should be extended to a medically assisted death, she said.

    "It's not going to cause extra people to die, these people are dying anyway. But the manner of their death will be so much more supportive, compassionate and kind."

    Heather Gregory wants voters to take the End of Life referendum choice seriously this election.

    Heather Gregory wants voters to take the End of Life referendum choice seriously this election. Photo: RNZ

    Heather hopes the law will be passed.

    "I don't want anyone to have to go through what Richard went through."

    RNZ will continue its coverage of the End of Life Choice Act leading up to the new referendum date - 17 October.



  • 31 Aug 2020 9:40 AM | Philip Patston (Administrator)

    Source: Newsroom

    As well as picking a preferred party and candidate, voters will have their say on euthanasia and the Cannabis Legalisation and Control Bill. Here's what you need to know about the End of Life Choice Act.

    In 2016, Sir Geoffrey Palmer delivered the first Lecretia Seales memorial lecture. The topic was law and life.

    Palmer, a former prime minister, knew Seales well, having worked with her at the firm Chen, Palmer and Partners, and again when he was president of the Law Commission.

    Seales was first diagnosed with brain cancer in 2011. (Opponents of “assisted suicide” point out she was initially “given only weeks to live”.)

    She lived as full a life as she could, travelling to Buenos Aires to dance the tango, and tripping to San Francisco, Bermuda and Morocco.

    But the symptoms soon set in. She needed a walking stick, couldn’t drive, and needed help to dress. “She became seriously impaired,” Palmer said in his lecture. “She experienced increased pain.”

    The prospect of a slow, unpleasant, painful and undignified death weighed heavily on her mind, Palmer said. She felt deprived of options. (Seales’ mum Shirley told Newshub she thinks her daughter might not have chosen to end her life.)

    After researching a ground-breaking Supreme Court decision in Canada, Seales took a case for assisted dying to the High Court in Wellington. It became known as Lecretia’s Choice. She told the court: “If my death is manageable I should be the one to manage it.”

    Justice David Collins’ decision was read to Seales before she died on June 5, 2015. The case failed.

    “But the case and the evidence contributed powerfully to ensuring that the adequacy of New Zealand law on this subject would be examined,” Palmer said a year later.

    That examination has now passed through Parliament and its fate will be decided by voters, in the end of life choice referendum.

    Controversy and divisions

    The End of Life Choice Bill’s passage was controversial and difficult.

    The justice select committee, which considered it, couldn’t agree the bill be passed. (It did pass, in a conscience vote, 69 votes to 51, in November last year, with the caveat the issue would go before voters in this year’s election.) Some committee members insisted that assisted dying be described as “suicide and euthanasia”.

    There were 39,159 submissions. Of the 36,700 written submissions, about 90 percent opposed it. (However, a 2018 Newshub poll, and many others, have suggested most Kiwis supported euthanasia.) Hearings for the 1350 oral submitters were held from Whangarei to Invercargill.

    Opposition came from many quarters.

    The Medical Association, the country’s largest medical organisation, with more than 5000 members, was against “euthanasia and doctor-assisted suicide”.

    Beyond what it believed was serious shortcomings and technical flaws in the bill, it said the practices were “unethical and harmful to individuals, especially vulnerable people, and society”.

    “Euthanasia in any form conflicts with the ethical principles of medical practice and would change the fundamental role of the doctor and the doctor-patient relationship.”

    Some doctors, however, supported the bill on compassionate grounds, having seen patients in terrible pain and knowing nothing more can be done for those patients.

    (A 2018 survey conducted for New Zealand Doctor magazine found 52 percent of doctors opposed assisted dying if death was imminent, while 32 percent supported it.)

    ACT leader David Seymour introduced the End of Life Choice Bill. Photo: Lynn Grieveson

    Some palliative care professionals believe assisted dying conflicts with the basic principle of their practice – to “neither hasten nor postpone” death.

    Concern about family members manipulating and coercing elderly people were raised by aged care workers. Elderly and sick people can often feel they’re a “burden” to their family, and could feel pressured, the select committee was told. Some aged care professionals didn’t want assisted dying to take place at their workplace.

    Meanwhile, some seriously ill people said legal assisted dying would mean they could die more peacefully, with family around. Others suggested suffering is an important part of the human experience, which would be compromised. Modern medicine already provides adequate pain relief, some submitters said, and is improving every day.

    Faith-based groups referred to the sanctity of life. Only God should decide the timing of life and death, they said. Euthanasia and suicide are morally wrong, and contradict religious teachings.

    Some worry that Māori and Pasifika people already have high suicide rates and this law change would make it worse.

    On Lecretia’s Choice, Justice David Collins wrote in his 2015 High Court judgment: “I fully acknowledge that the consequences of the law against assisted suicide as it currently stands are extremely distressing for Ms Seales and that she is suffering because that law does not accommodate her right to dignity and personal autonomy.”

    Whether New Zealand allows a law change enabling euthanasia – a Greek term meaning “good death” – is in the hands of voters.

    What is the question?

    The referendum asks: “Do you support the End of Life Choice Act 2019 coming into force?” Your options are yes or no.

    But didn’t the Act pass already?

    It did, but it’ll only come into force if more than 50 percent of voters tick ‘yes’.

    What does the Act do?

    It gives people with a terminal illness, who meet certain criteria, the option of legally ending their lives with medical assistance. It also sets out the process by which that can happen.

    Has this been before Parliament before?

    Yes, assisted dying bills were debated in 1995 and 2003 – in both instances, they were defeated at the first reading. A 2012 bill was withdrawn before the following year’s election.

    Would New Zealand’s Act lead to euthanasia tourism?

    No. To be eligible you’ve got to be a New Zealand citizen or resident, and aged over 18. You must have been diagnosed with a terminal illness that is likely to end your life within six months and be competent to make an informed decision. The other criteria are you’re at an advanced state of irreversible decline in physical capability and experiencing unbearable suffering.

    What would it mean for life insurance?

    People eligible for this process are suffering from a terminal illness, and, for the purposes of life insurance, that’s what they would have died from.

    Who would not be eligible for assisted dying?

    Those who, as their only reason for asking for an assisted death, say they’re disabled, of “advanced age”, or suffering from a mental disorder or mental illness.

    How would the conversation go?

    A person with a terminal illness tells the “attending medical practitioner” – their doctor – of their wish to legally end their life. That doctor must then provide the prognosis for the person’s terminal illness and have a serious talk about the consequences – or, as the Act puts it, the “irreversible nature” and “anticipated impacts” of assisted dying.

    How could a doctor be sure the decision was that person’s own free will?

    There’s a checklist. The doctor must talk to their patient regularly – the Act says “at intervals determined by progress of their terminal illness” – and be sure they understand other options for “end-of-life care”. They’re to be told they can change their mind at any time, right up to when the “medication” (some would prefer the term “lethal drug”) is administered. The doctor must encourage, but not force, the person to discuss their wishes with family, friends and counsellors, and be sure they’ve had the opportunity to do so. If permission is granted, the doctor must also talk to the person’s family members. Another check is the doctor must confer with other health practitioners in regular contact with the patient.

    What if there was a suspicion they were being pressured?

    The process stops.

    And if the checklist was completed without incident?

    The doctor records everything they’ve done to comply with the checks. Then the person – or, if they’re unable to write, their proxy – must sign and date the form, in front of the doctor. The proxy must be over 18, mentally capable, must not know they could benefit from the person’s death, and can’t be their doctor. The signed form is sent to a registrar.

    The registrar?

    They are a Ministry of Health official, one of three new roles created under the Act, should it come into force. The others are the Support and Consultation for End of Life in New Zealand group, or SCENZ, and the End of Life Review Committee. They have various responsibilities, including maintaining a list of doctors who are willing to act as replacements for conscientious objectors or independent doctors.

    Doctors could object?

    Yes. They can refuse to take part in the process, and can’t be penalised for that refusal. Once they’ve declared their objection, they tell their patient they have the right to ask for a replacement doctor. Doctors who take part in the process, and follow the rules, are immune from prosecution.

    After the form was sent to the registrar, what would happen?

    If the person’s deemed eligible for assisted dying by the doctor, a second opinion must be sought from an independent doctor. They read the medical files and examine the person. If they reach the same opinion, a form is completed and sent to the registrar and initial doctor. If either doctor is unsure about the competence of the person to make an informed decision, a third opinion is sought from a psychiatrist.

    What if a person is deemed ineligible?

    They can’t get assisted dying. Doctors, and a psychiatrist, if consulted, have to explain their reasons to the person.

    And if they are eligible?

    The doctor has another list of tasks to complete, after which another form is filled in and sent to the registrar. The person must be told they are eligible for assisted dying, and a discussion had about the progress of their terminal illness. They must be advised they can change their mind at any time, or defer when to receive the medication by up to six months. A date and method for assisted dying is chosen.

    What are the proposed methods?

    There are four: ingestion, triggered by the person; intravenous, triggered by the person; ingestion through a tube, triggered by the doctor or nurse practitioner; injection administered by doctor or nurse practitioner. (While all are covered by the term “assisted dying”, if the final act is done by a medical professional it’s deemed “euthanasia”, while self-administration is known as “assisted suicide”. In some countries “palliative sedation” is offered to the terminally ill, which means they stay in deep sedation until they die.) The prescription for the lethal medication must be written at least two days before the chosen date. The registrar notifies the doctor if they are satisfied the process has been complied with.

    What would happen on the day?

    The person must be asked if they choose to receive the medication at that time. If not, they can nominate another date, within six months, or stop the request altogether. The registrar is advised of any change of plan.

    And if they agreed to receive the medication?

    The doctor or nurse practitioner gives it to them, and must remain nearby until they die. A report is made to the registrar, including information about the person and the medical staff attending.

    Would the process be public?

    No, it’s confidential.

    When would the Act be reviewed?

    After three years, with further reviews every five years after that.

    Where in the world does assisted dying happen?

    Switzerland, the Netherlands, Belgium, Luxembourg and Colombia allow it, under certain criteria, as do many states in the United States. Most recently, assisted dying laws have been passed in Canada and the Australian state of Victoria.

    What is their experience?

    Numbers of assisted suicides and euthanasia are increasing. In Switzerland, for example, cases of legal assisted dying have increased from 187 people in 2003 to 928 in 2016. In Oregon, terminally ill people who ended their lives through “voluntary self-administration of a lethal dose of medications” under its Death With Dignity Act have risen from 59 people in 2009 to 188 people last year.

    Has it been ‘successful’?

    It depends on who you talk to. Supporters will say increased use of assisted dying is a sign of safe and effective laws, with appropriate safeguards. Interestingly, in Oregon, the use of palliative care has increased alongside the increase in assisted dying. However, opponents raise concerns of a “slippery slope” – that the law has gone beyond the terminally ill to people with disabilities or mental illness. There are such concerns in the Netherlands, but it’s not evident elsewhere, like Oregon. Doctors involved in assisted dying in the Netherlands, Belgium and Oregon have been investigated for malpractice.

    What’s happening across the ditch?

    Victoria’s Voluntary Assisted Dying Act came into effect in June last year. In the first six months, 52 people in Victoria chose to end their lives under the Act’s process.

    Click here for Newsroom’s full euthanasia section.

    The Referendums website has a summary of the End of Life Choice Act and frequently asked questions section.


  • 28 Aug 2020 10:07 AM | Philip Patston (Administrator)

    Paul Spoonley - WikipediaProfessor Paul Spoonley from Massey University has a theory.

    "I suspect what's happening is that it's a report card on how well the government has done up to this point but the Chinese voters are thinking about the future and what needs to happen next so that's why they're very focused on things that will stimulate the economy and which will address their concern."

    He said all parties have done little to canvass the vote of minorities living in New Zealand.

    "I think one of the things that surprise me a little bit is how little the major political parties are thinking of the immigrant, minority and ethnic vote. I would have expected to see more of a pitch in terms of candidates and policies which address the concerns of these communities."

    The survey also asked Chinese New Zealanders about the two upcoming referendums and found fairly definite trends.

    Almost 84 percent say they support the End of Life Choice Act, but just over 82 percent say they are against cannabis legalisation.

    The survey also shows Chinese voter turnout rate is at 78 percent, largely in line with the national average of 79 percent.

    Dr Andrew Zhu, director of Trace Research, which conducted the survey, said information from the poll might help political parities shape their future policies.

    "The purpose of this poll is to encourage Chinese voters to care about their democratic rights and engagement with the upcoming general election and also that could help Chinese perceptions be better understood by wider communities of New Zealand."

    Data were collected between 3-16 August through email and social media platforms and covers ethnic Chinese who were born in New Zealand and those from mainland China, Hong Kong, Macau, Taiwan, Singapore and Malaysia.

    The margin of error is +/- 2.64 at the 95 percent confidence level.


  • 26 Aug 2020 12:22 PM | Philip Patston (Administrator)

    Source: Otago Daily Times

    If the End of Life Choice Act comes into force after a "Yes" vote in the upcoming referendum, how will it work and who will oversee it? Mike Houlahan reports.

    If the "Yes" vote wins on October 17, do not expect a sudden rash of assisted deaths in New Zealand.

    For a start, the Bill would not come into effect until 12 months later.

    Secondly, the architect of the proposed law change, Act New Zealand leader David Seymour, was careful to put several safeguards against potential misuse of the legislation, and through the extensive debate on the issue, his fellow politicians proffered several more.

    Some argue the strictures are too restrictive and will mean the option to seek assisted dying will not be readily available for those who wish to use it; others believe it does not go far enough to protect the vulnerable.

    If New Zealanders vote "yes", how will the system work?

    Who?

    To receive assistance to die, a patient must meet all the criteria.

    They must be:

    ■ 18 or over;

    ■ A citizen or permanent resident of New Zealand (to avoid so-called "suicide tourism");

    ■ Suffer from a terminal illness likely to end their lives within six months;

    ■ Be in an "advanced state of irreversible decline";

    ■ Suffering in a way they consider intolerable;

    ■ Competent of making an informed decision.

    The law states being disabled, mentally ill or old cannot be given as the sole reason to apply for assisted dying.

    Being competent to make such a momentous decision requires being able to understand what assisted dying is, being able to retain, weigh up and use that information, and then communicate one’s decision.

    If?

    The patient must tell their attending medical practitioner — who can conscientiously object if they wish — that they want assistance to die.

    If the doctor has a conscientious objection, a replacement can be called in.

    It must be the patient’s own free choice: neither the medical practitioner nor anyone else can make that suggestion, and the practitioner must stop the process if they believe anyone is putting pressure on the patient.

    The practitioner must give the patient a prognosis of their illness, ensure they understand assisted dying and what other options they have, that they know they can change their mind, and ensure the patient has discussed their wishes with anyone they might wish to — although the patient is able to not seek counsel from anyone if they so choose.

    The patient, or someone else if they are unable to write, must then fill in a form, as must the practitioner.

    An independent medical practitioner must then be brought in who will read the patient’s file, examine them, and reach the same conclusion as the first practitioner.

    If there are any doubts on behalf of either practitioner that the patient is not competent to make the choice they have, a psychiatrist must examine the patient and then reach an opinion on their ability to make their choice.

    If they decide they are not, they are not eligible for assisted dying.

    Advance directives — written instructions authorising euthanasia — are not permitted under the law.

    Nor can a person with power of attorney over the patient make any decision on their behalf under the Act.

    How?

    Four methods of assisted death are provided for in the legislation:

    ■ Ingestion, triggered by the patient;

    ■ Intravenous delivery, triggered by the patient;

    ■ Ingestion through a tube, triggered by an attending practitioner;

    ■ Injection administered by a practitioner.

    When?

    The patient decides both the method and the time when they will be assisted to die.

    At that time the patient must again be asked if they wish to die, die on another day not more than six months later, or not die at all.

    If they choose to die, the chosen procedure goes ahead; if not, the drug is immediately removed and destroyed if no longer required.

    If the procedure does go ahead, the practitioner must file a report detailing all the circumstances of the death.

    Oversight

    The Act sets up two independent organisations and one role within the Ministry of Health to monitor and administer the law.

    A registrar will be appointed by the ministry to check processes have been followed in all cases, and notify a practitioner if a patient wishing to die has met all the eligibility criteria.

    The registrar will handle and refer any complaints, and must report to Parliament annually.

    The Support and Consultation for End of Life in New Zealand (SCENZ) group will be set up by the Director-general of health.

    It will make and maintain a list of practitioners willing to assist a patient to die, examining psychiatrists, and pharmacists prepared to dispense the required drugs.

    The Minister of Health will set up an End of Life Review Committee.

    Comprising a medical ethicist, a doctor who is a specialist in end-of-life care, and one other health practitioner, the committee will review practitioner’s reports and report to the registrar if any issues have arisen.

    If the Act comes into force, the Minister of Health must review it within three years, and further reviews must be held every five years.

  • 26 Aug 2020 12:16 PM | Philip Patston (Administrator)

    Diversity New Zealand's Managing Director, Philip Patston, looks at arguments about NZ's End-of-Life Choice Act and uncovers issues not usually discussed.

    As the debate about the EOLC Act continues, one thing that has become patently obvious to me is that the arguments against are mainly founded on emotion, while those for the Act are, in the main, factual.

    Opponents speak of coercion, the “slippery slope”, saving healthcare dollars and (somewhat humorously) the possible likelihood that someone’s life expectancy might increase after they have died with medical assistance. They also imply that, once someone has chosen MAID, they will somehow then have a duty to go through with it and will not be allowed to change their mind.


    Apart from some of these claims being ludicrous, particularly the latter two, they all tap into emotions of fear, helplessness and a lack of agency over one’s life (or death). They appeal to worst-case scenarios that lead people to think that the Act, if in force, will somehow be a trojan horse for the cruellest of human nature to rear up and eliminate the weakest in society.

    Comparatively, those in favour of dignity in dying veer towards impartial facts, for example, the Act applies ONLY to those who are imminently dying and are experiencing unbearable pain and suffering; and that MAID is a personal choice, enables a dignified and compassionate death and leaves families with good memories. These assertions are able to be proven by consulting the legislation and listening to the personal stories of those who have been involved in assisted dying.

    Returning to the nay-sayers, there is one argument proffered that I find particularly disturbing: It is that disabled, elderly and mentally unwell people will use the Act to “escape” abuse, neglect, loneliness and a lack of support provided by health, disability and mental health services. I said these arguments are disturbing – actually, I think they are insidious.

    Let’s get the obvious untruth out of the way first. Being disabled, elderly or mentally unwell are conditions that, on their own, will not make one eligible to use the provisions of the Act in Aotearoa. Period. No argument. The rules do not apply.

    The more treacherous part of this argument is that it serves to conflate two very different issues: The appalling ineffectiveness of support services and the right to choose a good death.

    Having relied on disability support services myself for more than 50 years – and often having to spend months or sometimes years fighting to get even my basic needs met – I totally agree. These services are appallingly underfunded and badly executed. It’s about the only fact to which opponents refer. This is not, however, grounds to deny me or any other person in Aotearoa the right to choice at the end of life.

    The inefficacy of these services is underscored by the fact that medical advances are keeping more and more premature babies, seriously injured accident victims and elderly people alive (often without choice), but sentencing them to a life of inadequate support and low value. And then EOLC opponents would want these “lucky people” to also suffer a painful, intolerable death.

    I have this to say to those who oppose my right to choose in the last six months of my life: If you are scared that I may want to escape a life I didn’t choose and the hardship caused by our poorly-run support system, please put your energy into lobbying to better that system. As for the end of my life, that’s my choice within the bounds of the humane End-of-Life Choice legislation.


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