End-of-Life Choice Society of NZ Inc News

Western Australia voluntary assisted dying legislation continues worldwide trend

Philip Patston — Tue, 10 Dec 2019 21:19:38 GMT

Wednesday, 11 December 2019, 9:13 am
Press Release

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.

WA legalises voluntary assisted dying

Philip Patston — Tue, 10 Dec 2019 19:42:17 GMT

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."

Referendum on the End of Life Choice Act

Philip Patston — Tue, 03 Dec 2019 04:13:40 GMT

The NZ Government has released the following information:

This referendum will determine whether the End of Life Choice Act 2019 comes into force

This referendum will give the public the opportunity to vote on whether the End of Life Choice Act 2019 should come into force.

The End of Life Choice Act 2019 gives people with a terminal illness the option of requesting assisted dying.
Parliament has passed the End of Life Choice Act 2019. But it has not come into force (started operating as law).
The End of Life Choice Act 2019 will only come into force if this receives majority support in a national referendum (more than 50% voting in favour).

The Referendum Question

The question is:

Do you support the End of Life Choice Act 2019 coming into force?

Yes, I support the End of Life Choice Act 2019 coming into force.
No, I do not support the End of Life Choice Act 2019 coming into force.

Key Terminology Used

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:

the administration by a medical practitioner or nurse practitioner of medication to the person to relieve the person's suffering by hastening death; or
the self-administration by the person of medication to relieve their suffering by hastening death.

Medication. In the End of Life Choice Act 2019, this means the lethal dose of the medication.

The End of Life Choice Act's Core Elements

The Act is built on three core elements:

defining who is eligible for assisted dying (the eligibility criteria)
ensuring that the person requesting assisted dying is competent to understand the nature and consequences of their decisions (establishing competence)
ensuring there is free choice, made without coercion, to engage in the process.

Eligibility criteria (clause 4 of the Act)

To be eligible for assisted dying, a person must meet ALL of these criteria:

be aged 18 years or over
be a citizen or permanent resident of New Zealand
suffer from a terminal illness that is likely to end their life within 6 months
be in an advanced state of irreversible decline in physical capability
experience unbearable suffering that cannot be relieved in a manner that they consider tolerable
be competent to make an informed decision about assisted dying.

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.

Establishing competence (clause 4A of the Act)

A person is competent to make an informed decision about assisted dying if they can:

understand information about the nature of assisted dying
retain that information to the extent necessary to make the decision
use that information to weigh up and inform their decision
communicate their decision in some way.

Ensuring there is free choice, made without coercion (clause 8 of the Act)

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:

periodically discusses the choice with the person, and ensures that they understand their other options for end of life care
talks with other health practitioners who are in regular contact with the person, and with members of the person's family/whānau with the person's permission
ensures that the person knows they can change their mind at any time.

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 of assisted dying

The request for assisted dying

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.

Establishing eligibility

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.

Choosing the method and time of assisted dying

If the person is eligible and competent, they select a method for receiving the medication, and when they want to receive it.

Administering the medication

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.

What happens after the votes are counted?

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)

Tess Nesdale responds: 'Rest homes struggling to care for patients admitted to die'

Philip Patston — Mon, 02 Dec 2019 21:30:48 GMT

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.

Tess Nesdale

Interview: Hospice boss Mark Jarman-Howe: ‘Why am I the only one speaking out on assisted dying?’

Philip Patston — Mon, 02 Dec 2019 21:15:41 GMT

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.”

Jay Kuten: Religious zealots should not foil a dignified death

Philip Patston — Sun, 24 Nov 2019 23:17:43 GMT

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.

Euthanasia vote: Lecretia Seales' mother celebrates victory – Lecretia "would have been over the moon."

Philip Patston — Sun, 17 Nov 2019 00:33:28 GMT

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.

What is the End of Life Choice Bill?

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.

Who would be able to ask for assisted dying?

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.

How would assisted dying actually work?

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.

Can you change your mind?

Yes. Patients are allowed to change their minds at any point.

What's been the major concerns?

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.

How would it be policed?

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.

So what happens now?

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.

Response to “A Good Death: Queensland Religious Leaders’ Joint Statement on the provision of high-quality end-of-life care"

Philip Patston — Sat, 16 Nov 2019 23:38:40 GMT

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.)

Contact details:
Dr Sid Finnigan E: S&S Finnigan sidsonya@bigpond.net.au 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.

Response

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.

Response

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.

Response

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.

Response

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.

Author details

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,

End of Life Choice Bill passes: What it means

Philip Patston — Thu, 14 Nov 2019 23:22:58 GMT

Source: NZ Herald

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?

What is the End of Life Choice Act 2019?

Who would be able to ask for assisted dying?

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.

How would assisted dying actually work?

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.

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.

Can you change your mind?

Yes. Patients are allowed to change their minds at any point.

What's been the major concerns?

Opponents of the legislation have raised several issues but the most common has been about 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.

How would it be policed?

So what happens now?

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 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.

Justice Minister Andrew Little has said the Government will try to provide objective information to the public ahead of the vote.

Plans to combat misinformation in election-year referendum debates

Philip Patston — Thu, 31 Oct 2019 04:02:40 GMT

Source: RNZ

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 End of Life Choice Bill

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."

Big news as UK police commissioners call for law review

Philip Patston — Sat, 26 Oct 2019 22:45:48 GMT

Source: Dignity in Dying

A big development this week as 18 police and crime commissioners have written to the Secretary of State for Justice calling for an inquiry into the the current law on assisted dying. This ground breaking intervention shows the current law is unsafe and virtually unenforceable.

This follows the news that Durham Police and Crime Commissioner, Rob Hogg, has been diagnosed with terminal motor neurone disease and is campaigning for a more compassionate law.

We've always known the current law is failing people, forcing some to suffer against their wishes and others to take drastic action to control their death. But we've constantly been told by some MPs that the law is sympathetic and compassionate!

This announcement by police and crime commissioners shatters that illusion.

We all agree that vulnerable people must be protected, that is not happening under the status quo. The ban on assisted dying merely drives the practice behind closed doors and abroad, with seriously ill people often ending their lives prematurely for fear of becoming too ill to act.

There is a scattergun approach to enforcing the law. Either there is no scrutiny at all or loving family members are criminalised for acts of compassion. How can the law be working well when it forces people to endure distressing and intrusive investigations at great cost to the tax payer?

When half of police and crime commissioners across the country recognise that a law is not working, law-makers have a duty to listen.

It is time for a Ministry of Justice-led inquiry into the blanket ban on assisted dying.

End of Life Choice referendum on the cards after tight vote in Parliament

Philip Patston — Wed, 23 Oct 2019 21:55:06 GMT

Source: Stuff

New Zealanders will likely be asked to decide whether euthanasia should be legal in a referendum at the 2020 election after a tight vote in Parliament.

David Seymour's End of Life Choice Bill was amended on Wednesday night to include a binding referendum on whether it should come into force, by a knife-edge vote of 66 to 54. (See also the Hansard report on Parliament's website.)The referendum is not certain as the bill still has to make it through a third reading vote next month.

But the referendum gives it a much higher chance of passing as it keeps NZ First on board with the legislation.

The bill would allow the terminally ill to request assisted dying from their doctors under specific circumstances.

Seymour mostly kept together his coalition that helped him pass the second reading of the bill, although 10 previous "yes" votes voted against the referendum, while three previous "no" votes voted for it.

A majority of Labour MPs (28) voted for the referendum, including leader Jacinda Ardern. A majority of National MPs (39) voted against it, including leader Simon Bridges.

Seymour struck a deal with NZ First early in the bill's passage to get the party's support for the bill in exchange for the referendum.

He and many other supporters of the bill are not generally supportive of the bill being a referendum, but understood the need for it to go to one in order to pass the next vote.

"This referendum clause is critical to keeping a coalition of MPs to be able to give people choice at the end of their life," Seymour said at the opening of the debate.

Labour MP and supporter of the bill Kieran McAnulty said he didn't support the referendum but would support it to give the bill a shot at becoming law.

"I think of other issues that have faced this country over time: the right to give women the vote, for example. If that was put to a referendum, that probably wouldn't have passed. The Homosexual Law Reform Act: if that was put to a referendum, that probably wouldn't have passed," McAnulty said.

"In a perfect world, I would have voted "no" on a referendum. But what I need to weigh up is in sticking to that principle which I believe in, can I then, in good conscience, see this bill fail? I cannot. So I will be voting for this referendum, because I am a bookmaker and I know how to count, and I know that if the referendum Supplementary Order Paper fails, so too does the bill, and in good conscience I can't let that happen."

National and Labour MPs are allowed to vote freely on the bill as a conscience issue, while Green and NZ First MPs voted as a bloc to support it.

Since the referendum question will simply ask if "the End of Life Choice Bill" should become law many opponents of the bill argued that its name should be changed to make what the bill legalised clearer.

National MP Tim Macindoe drafted a failed amendment that would rename the bill the "Euthanasia and Assisted Suicide Act 2019".

National's Chris Penk, a strong opponent of the bill, said the title needed to be free from euphemism.

"So if there is ever a situation in which it would make sense to have a bill with a title that does what it says on the tin—notwithstanding the provisions within the Act or the bill—then this would be that situation," Penk said.

Maggie Barry, another National MP strongly against the bill, said the title was "misleading and euphemistic".

NZ First MP Jenny Marcroft, whose amendment added the referendum, said it was key that such a change to the "fabric of society" should go to the public.

"We believe that temporarily empowered politicians, which we all are in this chamber, alone should not decide on this bill, but we should have the courage to allow the voting public to participate in this conversation," Marcroft said.

Supporter of the bill Labour MP Willie Jackson said he was struggling to work out whether to support the referendum or not.

"Referendums do not treat minorities well," Jackson said.

Labour MP Louisa Wall directly criticised NZ First for putting MPs who supported the bill but were against a referendum in an "untenable" position.

"I can't in good conscience, even though I 100 per cent support the bill," Wall said.

"My principles will not let me vote for the referendum. Even if it means the bill fails."

"It seems inconceivable that [NZ First] would say to this House that 'Unless you vote for this referendum we will vote this down at third reading.' I think that is appalling. That is abhorrent. We have been engaging in a good faith discussion on this since 1995."

Seymour said he was relieved after the vote but a big battle remained at third reading next month.

Long-time proponent of the bill and former Labour MP Maryan Street said she wasn't scared of the bill going to a referendum as many polls showed the public would support it.

"I don't fear a referendum. Every poll in New Zealand has had 70-75 per cent support in favour. I have no fear,' Street said.

The End of Life Choice bill was first put into the ballot by Seymour in 2015 and has had a tortured journey through Parliament, including a 16-month select committee process.

WHO VOTED HOW:

AYES (66)

Labour (29): ARDERN Jacinda, DAVIS Kelvin, LITTLE Andrew, ROBERTSON Grant, WOODS Megan, HIPKINS Chris, SEPULONI Carmel Jean, PARKER David, NASH Stuart, HUO Raymond, LEES-GALLOWAY Iain Francis, TINETTI Jan, PRIME Willow-Jean, FAAFOI Kris, ALLAN Kiri, CURRAN Clare, DYSON Ruth, ANDERSEN Ginny, LUXTON Jo RUSSELL Deborah, CRAIG Liz, LUBECK Marja, EAGLE Paul, McANULTY Kieran, RADHAKRISHNAN Priyanca, WARREN-CLARK Angie, O'CONNOR Greg, HENARE Peeni, WEBB Duncan.

National (15): BENNETT Paula, ADAMS Amy, KAYE Nikki, COLLINS Judith, MITCHELL Mark, BENNETT David, SIMPSON Scott, KURIGER Barbara, DOOCEY Matt, YANG Jian, BISHOP Chris, KING Matt, FALLOON Andrew, STANFORD Erica, YULE Lawrence.

NZ First (9): PETERS Winston, MARK Ron, MARTIN Tracey, TABUTEAU Fletcher, BALL Darroch, MITCHELL Clayton, PATTERSON Mark JONES Shane, MARCROFT Jenny.

Green (8): SHAW James DAVIDSON Marama, GENTER Julie Anne, SAGE Eugenie, HUGHES Gareth, LOGIE Jan, SWARBRICK Chlöe, GHAHRAMAN Golriz.

ACT (1): SEYMOUR David.

Independent (1): ROSS Jami-Lee.

NOES (54)

Labour (17): TWYFORD Phil, CLARK David,=sum SIO Aupito Tofae Sua William, O'CONNOR Damien, SALESA Jenny, JACKSON Willie, WILLIAMS Poto, WALL Louisa, WOOD Michael Philip, MALLARD Trevor, COFFEY Tamati, STRANGE Jamie, KANONGATA'A-SUISUIKI Anahila, MAHUTA Nanaia, WHATIRI Meka, RURAWHE Adrian, TIRIKATENE Rino.

National (40): CARTER David, PUGH Maureen, BROWNLEE Gerry, BRIDGES Simon, LOHENI Agnes, WOODHOUSE Michael, TOLLEY Anne, GUY Nathan, McCLAY Todd, SMITH Nick, BARRY Maggie, GOLDSMITH Paul, UPSTON Louise, NGARO Alfred, WAGNER Nicky, DEAN Jacqui, HUDSON Brett, LEE Melissa, BAKSHI Kanwaljit Singh, PARMAR Parmjeet, YOUNG Jonathan, HAYES Jo, McKELVIE Ian, O'CONNOR Simon, BAYY Andrew, DOWIE Sarah, MULLER Todd, RETI Shane, SCOTT Alastair, SMITH Stuart, BROWN Simeon, HIPANGO Harete, LEE Denise, PENK Chris, VAN de MOLEN Tim, WALKER Hamish, GARCIA Paulo, WILLIS Nicola, BIDOIS Dan.

The bill has faced strong opposition from a number of MPs, including National's Chris Penk.

Crucial euthanasia bill referendum vote on a knife-edge

Philip Patston — Tue, 22 Oct 2019 22:34:39 GMT

Source: NZ Herald

A crucial vote on whether to hold a referendum on legalising voluntary euthanasia looks set to go down to the wire, according to a poll of all MPs.

Act Leader David Seymour's End of Life Choice Bill will return to Parliament on Wednesday 23 October and politicians will have to decide whether the final decision should be put to the public if it passes a third reading.

If the referendum is rejected, the entire bill – which would let terminally-ill adults request assisted dying – will struggle to pass into law at the third vote, with New Zealand First looking like it may pull its support unless there's a referendum.

The Herald has polled every MP in Parliament and found 56 now say they will vote for the legislation to go to a referendum or are leaning towards it.

That counts a number of MPs, including Prime Minister Jacinda Ardern and Finance Minister Grant Robertson, have who indicated they will only back a plebiscite it there's no other way to get the bill through.

There's 46 MPs who have said they'll oppose it or are leaning against it. It needs 61 votes in the House to pass. The decision will be as a conscience vote, meaning MPs will vote individually, rather than along party lines.

But there's 18 MPs who have not said how they're voting.

And 10 of those undeclared politicians voted for the End of Life Choice Bill at its second reading. It's likely at least five or six of them will back the referendum to ensure the bill can pass into law, like their colleagues.

Under that situation, the referendum will pass, but only narrowly.

It means even a few MPs changing their minds could swing the vote against a referendum. Some members were understood to still be changing sides on Tuesday.

There is, however, a number of MPs who oppose the bill – such as Labour's Deborah Russell – who say it's a close decision and feel more comfortable with putting the issue to a public.

The group could possibly be joined by one or two more who were "no" at the second reading, but still haven't declared how they'll vote on Wednesday.

The referendum failing would spell serious trouble for the legislation as a whole.

The bill passed its second reading 70 votes to 50, but the referendum has been demanded by NZ First, which says the issue is too serious to leave to politicians.

How MPs voted during the second reading

Several of the party's MPs have previously said all nine of the party's members will vote against the End of Life Choice Bill if the public aren't allowed to decide.

Leader Winston Peters wouldn't confirm this week whether NZ First members would be allowed to back to the bill without a referendum.

Without their votes, Seymour would have to retain every other "yes" vote from second reading into the third – a major ask, given a number of MPs publicly expressed reservations even while backing the bill last time.

Seymour has made a series of changes to the bill since the second vote in a hope of securing further votes, but it's not yet clear whether that's won him any more votes.

That's why the Act leader has been trying to rally support for the referendum for months now, even though it would slow his legislation.

And it's why the End of Life Choice's opponents may be more likely to vote against a referendum.

Publicly, a number have also raised the same concern as the bill's supporters – that the issue is simply too complex to leave to a yes-no referendum question.

Polling would also suggest a referendum would get the public's backing.

Victoria University research fellow Jessica Young, an expert on the issue of assisted dying, saying over the past 20 years public support for some form of assisted dying has averaged about 68 per cent.

Public campaigns surrounding the End of Life Choice Bill this year don't appear to have shifted the mood much either, with a 1 NEWS Colmar Brunton Poll in July – ahead of the second reading – saying about 72 per cent of the public supported assisted dying.

Click here for a list of MPs who have indicated they'll only back the referendum if necessary to get the bill passed – it does not necessarily reflect their support for a referendum.

LONG READ: ‘We have to listen to our patients. It is after all their body’: Jersey GP on assisted dying debate

Philip Patston — Tue, 08 Oct 2019 22:24:54 GMT

Source: Jersey Evening Post

Even when doctors have just been surveyed on the subject, it still feels awkward to ask a GP about ending the life of a patient.

Dr Nigel Minihane, Saturday interview on assisted dying. Picture: JON GUEGAN. (25973012)

Despite the way that the results of a recent survey, answered by around a third of local doctors, have been used by those on both sides of the debate, they do not provide conclusive assistance. Was the notable thing the majority who thought it, sometimes or always, acceptable in given circumstances to assist someone with an incurable condition to end their life? Or was it the minority – a significant proportion, nonetheless – who thought it never acceptable in any circumstances?

Dr Nigel Minihane, chairman of the Jersey Primary Care Body, accepts that views within the profession are as polarised as those held by the public. Yet he detects a shift in the centre ground of public opinion to which the profession is starting to respond at national level.

‘We have to listen to our patients and it would appear that the public at large actually feels that a patient’s autonomy is something that has largely been ignored by the medical profession. Something like 80%-plus of the public are saying that we should be considering assisted dying and it would perhaps be rather arrogant of the profession not to listen’, he said.

Certainly, the signs nationally are that the official opposition to assisted dying may be being replaced by a more nuanced position. The Royal College of Physicians decided in March this year that it would take a ‘neutral’ position on the question, while the Royal College of GPs, which is currently opposed, is due to ballot its 53,000 members again shortly.

One of the things that makes the assisted dying debate so difficult is that the often distressing circumstances envisaged by the desire to escape life come into conflict with safeguarding the interests of the potentially vulnerable. But to talk about those circumstances with a doctor concentrates the mind.

‘In some situations, it is not so much the pain but the mode of death that might be severe. For example, there are rare conditions where a tumour might erode into an artery and there’s nothing you can do. It is going to burst and people are literally going to bleed to death.

‘It’s one of those circumstances where it’s ethically acceptable now to give terminal sedation [a substantial dose of morphine beyond that required for pain relief], but at the moment that’s only acceptable when that situation actually occurs. If someone knows that is the mode of death, would you look at it differently?’ Dr Minihane asks.

MISSING CAPTION (25981576)

Such dilemmas appear to transcend the normal boundaries of palliative – or supportive, as it is now known – care where the doctor ensures that the patient has access to appropriate symptom control throughout their illness. ‘Some of that is curative but some of it is about making sure life is bearable,’ Dr Minhane said.

Central to the debate is the patient’s right to choose. Whereas in the past you might have visited a doctor expecting to be told what do to, the assumption today is that, equipped with the relevant information – what Dr Minihane calls the doctor’s ‘braindump’ on a particular condition – a patient will make his or her own informed decision about their best interests.

Yet problems arise with patient autonomy when supportive care simply does not work and the patient’s pain cannot be controlled by the prescribed drugs, or when they do not want to endure their illness and the palliative treatment.

‘If they know they are on a trajectory to death or unbearable suffering what about their decision then? It is, after all, their body.’

For Dr Minihane the patient-doctor dialogue which takes place in relation to a minor complaint – whether, for example, to take antibiotics for the condition – should also take place in relation to serious illness.

‘At the cancer end of life the same should apply. We tell a patient: this is what we can do. We can’t cure you but this is how we can make life better for you. But perhaps the autonomy which we have made the central pillar of what we do isn’t being addressed in the same way at the end of life as it might be,’ he said.

The present position is clear legally. Both assisted dying, where patients are given a cocktail of drugs to take that will end their life, or euthanasia when their death is brought about by a third party are not paths available here.

‘In these situations we have to point out that it is illegal and we point out all the alternatives. What we are trying to ensure is that people have their symptoms controlled so that we can give them the best quality of life for as long as possible.

‘For me that’s no different from what we do everyday as a doctor so, whether someone comes into the surgery with a cold or cancer, I often say to them my job is to make life as good as I can for you for as long as I can. There may be other circumstances that prevent me from doing so but that’s my job.’

However, it is precisely those ‘other circumstances’ which lie at the heart of the current debate, situations when the suffering of the patient or the patient’s attitude to their situation mean that they cannot exercise their own control in the way they might wish.

‘I remember seeing one gentleman years ago with a cancer of the lower bowel which had eroded through the bowel and went into part of his spinal cord and the peripheral nerves, and he died in severe pain. His mother came to me afterwards and her words echo in my head, “My son died in pain” and I had to agree that he did.’

Central to the debate about assisted dying is the question of safeguards. How to ensure, if the law were changed, that only those in agreed circumstances, governed by their medical condition and its prognosis, and free from coercion would be able to obtain help to die.

The difficulty was brought into sharp focus during one of this year’s BBC Reith Lectures given by former Supreme Court – and former Jersey Court of Appeal – judge Lord Jonathan Sumption who was challenged by a member of the audience to say whether he would support changing the law to permit assisted dying.

The lady who posed the question had been investigated by the police, having returned from Switzerland where she had taken her terminally ill husband to die. She was understandably distressed by the experience.

But Lord Sumption told her that the law should continue to make helping someone die a criminal offence, even if there was also acceptance that, in certain circumstances, it was right for people to break that law.

For Dr Minihane, the exchange has to be understood in the wider context of the lecture’s theme: the need for the courts not to intrude into affairs which are properly the territory of political decision-making. It is for the legislature rather than the judiciary to decide whether assisted dying is legal and, if it is, the circumstances in which it should be permitted.

What he calls those ‘specific delineated safeguards’ might include the patient’s terminal prognosis, their view that it was in their own best interests and the fact that they had capacity to make the decision.

Yet the recent local survey of doctors’ opinions highlights a further issue if the law were to be changed – the freedom of the doctor to opt out if they entertained honest objections.

‘If the law were changed I think one would have to look at it in a similar way to the abortion debate where there are “conscientious objectors” among the medical profession who will not deal with abortion because of their religious convictions and it’s entirely appropriate that that remains’.

Dr Minihane sees an interesting distinction between the abortion debate which is about the mother’s choice in relation to an unborn child – within limits set out by the law – and the debate about assisted dying which involves dealing with a person who has the capacity to make a decision about themselves with appropriate safeguards.

So what about the view of Dr Nigel Minihane, not as a spokesperson for the Primary Care Body but as a general practitioner himself?

‘I think I would say that the important aspect is autonomy. I have changed my practice over the years and it’s all about the patient, the person in front of you and what they want.

‘If things are within the law and it’s something which in all conscience I can do then it’s something that I would consider. However, until the law is passed and the safeguards are established I couldn’t give a full opinion,’ he said.

Euthanasia bill moves forward in committee stage

Philip Patston — Wed, 25 Sep 2019 20:49:23 GMT

Source: RNZ

The End of Life Choice Bill has moved through another phase of its committee stage in Parliament and opponents' efforts to change the bill have again been voted down.

David Seymour Photo: RNZ / Ana Tovey

National MPs put forward around 20 amendments to ACT leader David Seymour's bill last night - but unlike the last session, where MPs stayed voting until 1am, the voting wrapped up at 10.30pm.

Mr Seymour's chief opponent Maggie Barry, who apologised for yelling at Labour's assistant speaker Ruth Dyson during the last debate was not in the House last night.

However, her proposed amendment still got a lot of air time through her colleagues.

Ms Barry wanted the death certificate of someone who dies from assisted dying, for the purposes of any life insurance contract, to state that the person died as a result of the administration of medication.

National MP Melissa Lee told the House legislation shouldn't compel someone to misreport or misrepresent a cause of death.

"We should not try and hoodwink the actual reason why someone had in fact died ... this bill of David Seymour's is trying to actually say they did not in fact die from a lethal dose of a poison.

"That to me is actually a lie and I do not think that legislation should facilitate the falsehood," Ms Lee said.

But Mr Seymour said there's no deceit or deception going on.

"Under the requirements of this legislation, the death certificate says that the person died of the illness that qualified them to be eligible for assisted dying, also the fact that they died from assisted dying.

"So anybody reading that certificate I think can figure out that this was done under the law.

"There's no subterfuge, it's very easy for anybody to read and understand what that's saying", Mr Seymour said.

The amendment was voted down 38 votes to 81.

Alfred Ngaro Photo: RNZ / Dom Thomas

National's Māori, Pasifika, and ethnic MPs also tried to push for cultural considerations and the Treaty of Waitangi to be properly addressed by the bill.

MPs Harete Hipango and Alfred Ngaro put forward amendments that Deputy Speaker Anne Tolley ruled out of order because they related to other parts of the legislation that were debated weeks ago.

But Ms Hipango submitted another amendment during the debate and put forward her case.

"It is well known that the legislation of this land requires that commitment [to the Treaty] which has been mandated.

"I implore members of this House, I implore members of the public, that we have a duty of care and responsibility to our most vulnerable. This bill that's proposed has no lens, no optics whatsoever in terms of addressing that," she said.

Mr Ngaro accused Mr Seymour of being dismissive of the importance of cultural considerations.

"The question that has to go to the member of the Bill who talks about the importance of choice, what about the importance of ensuring that people know what choices they are making?

"Many times when we think about it in different cases with different cultures people may be asked a question, and if I talk about the Pasifika community, people will nod and say yes do you understand.

"The truth and the reality is they do not understand the technical implications in this regard," Mr Ngaro said.

But Mr Seymour said putting in a specific requirement around cultural considerations would be problematic.

"Of course we expect all medical professionals in New Zealand to be respectful of who their patients are, it would be quite extraordinary if that wasn't the case.

"And I think it would be a terrible signal for Parliament to send that in specific instances they're required to carry out those kinds of duties because the implication might be that they weren't expected to carry out duties of cultural competency in other settings," Mr Seymour said.

The End of Life Choice Bill will be up in the House again late next month when New Zealand First's proposal that the bill be put to the public in a referendum is expected to be debated.

Seymour Welcomes NZ First Referendum Question

Philip Patston — Thu, 19 Sep 2019 06:09:26 GMT

Wednesday, 18 September 2019, 3:02 pm

Press Release: ACT New Zealand

ACT Party Leader David Seymour has welcomed New Zealand First’s release of the question to be put to the public at a referendum on the End of Life Choice Bill.

“The wording of the question put forward by New Zealand First today will allow MPs to vote for a referendum knowing exactly what two options the public will be given to choose from at the election booths next year.

“SOP [Supplementary Order Paper] 361 in the name of Jenny Marcroft will give certainty to MPs that the wording of the question put before the public on the End of Life Choice Bill will be decided collectively by all of Parliament during debate on the Bill in Committee of the Whole House, rather than at a later stage by Cabinet.

“I support this SOP put forward by New Zealand First.

“I am confident that this question proposed by New Zealand First will ensure the fairest outcome at a referendum for both those for and against the Bill and ask all MPs to support its passage in the House.

The SOP can be found here »

Amendments made to help get End of Life Choice bill over the line

Philip Patston — Mon, 16 Sep 2019 04:52:21 GMT

Act Party leader David Seymour's voluntary euthanasia bill has cleared another stage in Parliament.

MPs voted 70 to 50 in favour of the End of Life Choice being given a third and final reading. But that was only after Mr Seymour introduced several amendments, including a requirement that doctors will not be able to suggest to patients they consider ending their lives.

David Seymour joined RNZ's Wellington studio to discuss the bill.

End of Life Choice Bill euthanasia law inches closer to final vote

Philip Patston — Sun, 15 Sep 2019 21:31:41 GMT

Source: NZ Herald

Euthanasia legislation has inched closer to a final vote in Parliament as opponents criticised the speed of the debate.

Act leader David Seymour's End of Life Choice Bill, which would allow terminally ill adults to request assisted dying, returned to the House on Wednesday night for the third of what will be five lengthy debates over last-minute changes.

The legislation passed its second reading by 70 votes to 50 in June and Seymour has promised a swathe of amendments to secure much-needed votes ahead of the third-and-final reading.

He scored another victory on Wednesday night as his latest tranche of changes was voted through 68 votes to 52 as the Committee of the Whole House debated a section of the bill that sets up the organisations that would oversee and monitor assisted dying.

It lays out requirements such as reviewing the legislation after three years and for a "Review Committee" that will have to look at reports about every death to see if there's any non-compliance.

Seymour's changes for this section were largely technical.

But those opposed to the bill put forward 35 of their own amendments this week, many trying to tighten the rules for who could be appointed to the oversight bodies.

"They must be beyond reproach," National's Melissa Lee told the House as she asked for backing for her amendment that would ban anyone who had ever faced a professional complaint from one of the panels to be set up.

Several of the amendments had yet to be voted on, but all 15 considered ahead of Seymour's were rejected.

It's part of the push and pull between the Act leader and the bill's critics that has characterised the debates.

Those against have largely dominated the time in the House, calling for as many speeches as the chair of the debate will allow, and making clause-by-clause attacks in an effort to show the bill as not safe enough given the seriousness of its implications.

National MP Chris Penk described his interrogation of the bill on Wednesday as a "fine examination".

While every amendment from opponents has so far been voted down, the individual vote called for each proposal has seen sessions in Parliament run long into the night and across days.

Seymour, meanwhile, on Wednesday went as far as to complain during the votes that the teller for the "noes" (the person counting their votes), Maggie Barry, was taking too long to count and criticising her for taking to Twitter in the middle of one vote.

In Barry's tweet, she argued the debate had been shut down for a vote too early in the night without all amendments being given proper time, describing it as a "terrible injustice".

The person chairing the committee - on this occasion Assistant Speaker and Labour MP Ruth Dyson - effectively gets to end the debate when they think there's been enough argument, as long as the majority of MPs agree.

What's already been changed?

The previous two debates saw a raft of major changes introduced by the Act leader, including:

• Limiting the bill to only apply to those with six months to live, whereas it previously covered people with "grievous and irremediable" conditions

• Prohibiting a health practitioner from initiating any discussion about assisted dying

• Giving employment protections for any doctor, nurse, or psychiatrist who objects to taking part in the process on any ground

• Explicitly stating that if any pressure is suspected on a person applying for assisted dying, doctors and nurses must stop the process

What happens next?

The bill will return to the House on September 25 for a fourth debate. But it's the fifth that will be the most contentious.

During that final session, MPs will have to consider whether to put the legislation to a referendum.

New Zealand First has demanded a plebiscite as a condition of its support and vowed to vote "no" if it doesn't get it.

Without NZ First's nine votes, Seymour could not afford to lose another single vote from the second reading - a difficult ask.

That's why he's promised to support the referendum. But with plenty of MPs taking a wait-and-see approach, it's not yet clear whether there's enough support in the House for him to get one.

Relieving suffering is a duty under the Hippocratic oath that should take precedence over preserving life

Philip Patston — Mon, 09 Sep 2019 22:13:08 GMT

Source: Letters, Herald Scotland

THE topic of assisted dying has been back on the discussion agenda recently, but I wonder if the subject is too polarised, and whether a more nuanced approach is necessary.

A relative of mine recently died in hospital, having existed, for several days, in excruciating pain on which the legal maximum palliative relief had no effect, while his wife and family had to sit by his bedside and watch as he kept pleading for release from the torture. Since this level of suffering is such as we would not allow an animal to endure, I cannot understand how it can be considered acceptable to inflict it on a human being, and I can only imagine the nightmare for the family at the bedside, let alone the trauma they will now have to live with for the rest of their days.

I once heard an Australian doctor suggest that this was not a matter of obeying the Hippocratic oath to prolong life but was simply prolonging death. Some say it is allowing nature to take its course, not deliberately ending a life, but if letting nature take its course is the correct approach, why treat other life-threatening illnesses and diseases? Is the reason in these other instances not to end suffering? Granted that the end result is hopefully to restore a viable life, does that mean that suffering should continue, no matter how unbearable, simply because death is the inevitable end?

I believe that relieving suffering is a duty under the Hippocractic oath that takes precedence over preserving life. For that reason, if at the end a patient is suffering ongoing excruciating pain, the prime consideration should be to alleviate that, even if the treatment may possibly, or even certainly, hasten the inevitable death. At least then there can be a dignified, peaceful and pain-free end to life. Where is the dignity or peace in a long-drawn-out death in agony?

Can we not stop regarding this as a question of “assisted dying” and instead regard it as a humanitarian process of alleviating suffering? Should we not allow whatever level of palliative treatment the degree of suffering requires, and regard the possible hastening of death as a compassionate side-effect? At the very least, we should allow people to put their wish for this in writing and guarantee to honour that wish. At the very least, can we not accept that concession?

This is exactly what I would wish for myself.

P Davidson, Falkirk.

There is no logic in not allowing assisted dying with the right safeguards

Philip Patston — Mon, 09 Sep 2019 22:02:28 GMT

Source: Letters, Herald Scotland

WHAT a sad set of circumstances that have led to Richard Selley ending his life, yes, in the way he would have wished but not at the time nor in the place that he would have preferred ("‘The end was dignified and calm... he had taken control’", The Herald, September 7).

Any pet owner has the right to end the suffering of a well-loved cat, dog or other animal.

It defies logic that under similar circumstances, with appropriate safeguards, a sentient human cannot terminate his or her own life, at the appropriate time and in a dignified manner.

Condolences to his family and friends and may this brave man rest in peace.

David Chadwick, Carluke.

GORDON MacDonald concludes his article against voluntary assisted suicide for the terminally suffering by quoting Leo Alexander, Chief Prosecutor at the Nuremberg trials: “It started with the acceptance by doctors of the idea, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived” ("Change to law would send a message some lives are worth less than others", The Herald, September 8).

Since what the Nazis were doing was killing people who very much wanted to live and since the present campaign is for terminally ill people in great distress to be able to choose to have their death hastened, the comparison is misleading in the extreme and comes very close to a smear. Opponents of assisted suicide often play down or ignore the fact that it would be entirely voluntary, with safeguards in place to ensure that the dying patient is making a considered choice and is not under the influence of a passing mood. Instead, such opponents spread a false impression that it would mean jackbooted doctors inflicting death on those who very much want to live. Dr MacDonald here shows himself to be of that number.

Paul Brownsey, Bearsden.

The Inescapable Truth – Nick Boles, UK MP

Philip Patston — Tue, 03 Sep 2019 22:27:35 GMT

The experiences shared in this report are as harrowing as anything I have encountered as a Member of Parliament. I have had two bouts of cancer and am no stranger to the nastiness of the disease and its treatments, but nothing prepared me for the horror of what is described here.

In 2019 British people are being forced to endure unbelievable suffering at the end of life. Some will retch at the stench of their own body rotting. Some will vomit their own faeces. Some will suffocate, slowly, inexorably, over several days, their last moments of life disfigured by terror. Any one of us might suffer such a fate.

[This is also happening in New Zealand.]

Read more here »

Fatal Fraud

Philip Patston — Tue, 03 Sep 2019 22:21:55 GMT

This is a film about a film. Fatal Fraud is a case study about techniques used by opponents against evidence-based public policy initiatives. In this film, Andrew Denton explains with the help of leading experts how emotional manipulation, fear, framing and omission are deployed to sow Fear, Uncertainty and Doubt in the minds of legislators and the public.

Watch the film here »

Report on the last Member's Day debate on the EOLC Bill – Maryan Street

Philip Patston — Mon, 02 Sep 2019 22:32:17 GMT

by Maryan Street

On 21 August, the House debated Part 2 of the EOLC bill. This was the very substantial part of the bill which dealt with processes and procedures. It was a protracted debate, with supporting MPs deliberately sitting quietly and not taking calls in order not to prolong the debate, while the opposition exhausted their arguments, the Speaker's patience and the whole House in the end. By agreement between the parties, while it did get to voting before 10pm, the House suspended voting part way through in order to avoid another late night marathon as had occurred in the previous debate.

That means that the next Member's Day on 11 September will BEGIN with the EOLC bill and the interrupted voting straight after the General Debate at about 4pm. There are no other bills ahead of it currently. There are 15 SOPs left to be voted on which pertain to Part 2, but an educated guess says that at least 5 of those will be ruled out of order by the Associate Speaker because they contradict David's amendments to the Part which have already been passed. So that leaves 10 SOPs to be voted on. I imagine that will take until about 5pm or shortly after. Then the House will move on to Part 3 which should not take very long because it is more technical in nature and should be disposed of by 10pm. That leaves Part 4 and the Schedules to be debated on the next day (25 September), and then Clauses 1 and 2 remain.

Clause 1 is the title of the bill, and there are some SOPs in to change that ("Assisted Suicide Bill" etc.) and Clause 2 is the Date of Commencement. It is in Clause 2 where NZFirst's SOP about a referendum will be debated, obviously because it will alter the date of enactment. That will be the last debate at the Committee stage. Thereafter, it moves on to its third and final reading which is a time-limited debate and will only take two hours (or a little more if the Business Committee decides to be generous and extend the time a little, as it did before). This will occur in October, all going well.

So there is not much longer to go!

Euthanasia: Safeguards against coercion inserted into David Seymour's proposed bill – Henry Cooke

Philip Patston — Mon, 02 Sep 2019 22:19:52 GMT

The next debate for the EOLC Bill will be Wednesday 11th September. We should see the 3rd Reading completed by the end of the year. What a wonderful Christmas present!

Source: Stuff

What's it like to help someone end their life? It's something doctors here could soon be doing, as David Seymour's End of Life Care bill passed its second reading [on 21 August].

The proposed euthanasia law has had new safeguards inserted to make sure that doctors cannot be the first ones to suggest assisted dying.

Other successful changes protect health professionals conscientiously objecting to euthanasia from employment repercussions, provide for patients delaying euthanasia, and further formalise the exact process that those seeking assisted dying would go through.

The changes were all inserted on the behest of the bill's sponsor David Seymour by 69 votes to 51 in a late-night Parliamentary session on Wednesday night, while the End of Life Choice Bill was in the second day of its committee of the whole house debate.

Seymour has been seeking to narrow the bill and strengthen protections in order to keep the loose coalition of MPs who have backed it so far onside for the third and final reading.

At the End of Life Choice Bill's second reading, MPs share their personal stories on why they support or are opposed to the legislation.

He was stymied in his attempt to do this through the 16-month select committee process but succeeded in his first day of debate several weeks ago, when he managed to narrow the bill so it only allowed the terminally ill to request assisted dying.

This was enough to keep the support of the Green Party, who had faced serious lobbying from the disabled community who were worried the bill would allow coercion.

David Seymour has been seeking to narrow his bill.

The debate on Wednesday concerned the exact process for assisted dying and went well past 11pm as a personal vote was called for on many of the proposed 31 amendments.

The bill now confirms that the patient must be the one to first suggest assisted dying. They then must make this request to their doctor or other health professional - who can conscientiously object, but must tell the patient that they can contact a special Health Ministry office who can help them find a practitioner who can help.

If that practitioner thinks it is appropriate they must make sure the consent is "informed" - that the person knows all of their options for care - and if the patients still wishes to go through with it the request must be put in writing.

Two doctors must then agree that the patient is informed and the criteria to request assisted dying are met, and if either of them are not sure if the person is making the decision themselves or with informed consent, a psychiatrist must be asked for their opinion. Any of the three doctors can veto the process.

A new change inserted by Seymour on Wednesday would allow a patient to defer this process for up to six months without having to start from the beginning again - or cancel it at any point.

"Evidence from offshore is that there is a palliative effect simply from having the choice. Once people know that they have the choice about how and when they die, if they want it, then that actually has a huge positive effect on their wellbeing," Seymour said.

Speaking after the bill was passed Seymour said much more work remained in the coming months of debate on the bill.

"It's long grinding process and there will be several months of this to come," Seymour said.

He said his change made sure that there was a "very low threshold" for suspicion of coercion that would stop the entire euthanasia process.

Opponents of the bill put forward several unsuccessful amendments to make the law more restrictive, including one from National MP Chris Penk which would create an advisory council to approve or disapprove of every case.

This amendment failed 71 votes to 49, a similar margin to the other amendments put forward by opponents to the bill.

Penk and other opponents made clear that they believed the bill was generally unsalvageable and that coerced deaths would still happen - so they would definitely not vote for the bill at third reading.

"Even if you are supportive of euthanasia in principle, this is certainly not the bill to deliver it," National MP Maggie Barry said.

Seymour still faces serious challenges before making the bill law.

He will need the win the support of the House for a referendum on the law to keep all of NZ First's nine votes for the third and final reading. The bill only passed its second reading with a margin of ten votes, so if all NZ First votes were to go, only a single MP changing their mind would see the bill sunk.

He said on Wednesday he was pleased his coalition of around 70 votes in favour was sticking with him on all the amendments.

Euthanasia bill: Trust gone – Jay Kuten

Philip Patston — Mon, 02 Sep 2019 22:08:53 GMT

On euthanasia, National is out of step with its own voters

Philip Patston — Mon, 05 Aug 2019 21:18:37 GMT

Source: The Spinoff

Fervent euthanasia opponent Maggie Barry is giving her party a headache that may last right up to next year’s election.

NATIONAL PARTY LEADER SIMON BRIDGES AT THE PARTY'S 2019 CONFERENCE (RADIO NZ/CRAIG MCCULLOCH)

When Judith Collins tearfully told Parliament during the second reading of David Seymour’s End of Life Choice Bill in June that she had been on “the wrong side” of the debate and now she was on “the right side” by voting in favour, it was impossible not to hear her sniffing the winds of political change.

It has gone mostly unremarked that of the five MPs who are commonly tipped as contenders to replace Simon Bridges as leader — Collins, Paula Bennett, Mark Mitchell, Nikki Kaye and Todd Muller — only Muller voted against the bill in June.

Departing Selwyn MP Amy Adams, who ran Bridges close in last year’s leadership race, also voted for it as did two MPs touted as future leaders — Nicola Willis and Chris Bishop.

Collins is smart and canny. Why would she want to remain not only on the wrong side of a majority of New Zealand voters, but also on the wrong side of a majority of National supporters — especially if she guesses the bill is likely to pass?

A Horizon poll published in May showed 65% of National’s voters approve of an assisted death for anyone with an end-stage terminal illness aged over 18 who is of sound mind and suffering unbearably.

Fifty-eight per cent of National voters also support assisted dying for adults with neuro-degenerative conditions, such as motor neurone disease, and who are suffering unbearably, even if their death may not occur in the immediate future.

However, while nearly all of National’s potential leadership contenders favour assisted dying, the bulk of the party’s MPs are dramatically out of step with the people they represent.

The second reading of the End of Life Choice Bill showed this glaring disjunction very clearly. Two-thirds of National voters want some form of assisted dying but only a third of National’s MPs — 18 out of 55 — voted in favour.

Another worry for National is that North Shore MP Maggie Barry is by far the most prominent opponent in the debate. Her campaign of opposition is often seen as being pursued with a reckless disregard for evidence and couched in exaggerated and inflammatory language.

And that is a problem for Bridges and his party because her aggressive and obstructive stance is unpopular with much of the public and her fellow MPs.

MAGGIE BARRY AT WELLINGTON BOTANIC GARDENS, 20 MARCH 2017 (PHOTO BY MIKE CLARE/ANADOLU AGENCY/GETTY IMAGES)

Before the End of Life Choice Bill returned to Parliament last week, Judith Collins told journalists that she hoped “people don’t play silly buggers” and abuse the process as it is debated.

Collins didn’t identify the “silly buggers” she was referring to but her comment has been widely interpreted to mean Maggie Barry and her religious allies.

Last Wednesday, hours before David Seymour’s bill was due to be debated, Barry fronted the media — accompanied by National colleagues Simon O’Connor, Chris Penk, Alfred Ngaro and Kanwaljit Singh Bakshi — to reaffirm their intention to lodge more than a hundred amendments.

National Party strategists must wonder what they have done wrong in an earlier life to deserve photos of a posse of their MPs splashed across the news media under headings such as: “Euthanasia critics look to drag out battle in Parliament.”

That banner could easily have read: “National MPs intend to filibuster a very popular bill that even their voters support.”

Barry denied that the 120 amendments they will lodge constitute filibustering. In fact, she doubled down, telling journalists: “I would imagine it could quite easily go beyond that [120] because you can make amendments on amendments.”

Proposing 120 amendments for a bill of only 28 sections is extraordinary but threatening amendments to amendments looks unrepentantly vexatious and a clear example of the abuse of process Collins warned against.

MIKE’S MINUTE, WEDNESDAY, 13 DECEMBER 2017

National has currently got the wind at its back after a successful party conference and a Colmar Brunton poll that put the party at 45%. What it really doesn’t need right now is months of negative publicity as Barry and her confreres are portrayed in the media as niggling spoilers.

Some of the sharpest critics include those normally sympathetic to National. After last Wednesday’s parliamentary debate, Mike Hosking told his Newstalk ZB audience: “Now, this [debate] ain’t over yet, not by a long way thanks to Maggie Barry and her mates who, despite what she claims, is doing herself no favours by stalling with her 100-plus amendments.”

And it’s not the first time he has criticised her.

At the time of the second reading of the bill in June, when he asked National’s Mark Mitchell what he thought of Barry’s role in the assisted dying debate, the Rodney MP replied: “No comment.”

Hosking later told his Breakfast audience, “When Mark Mitchell says ‘no comment’, you know exactly what he’s thinking. I just wonder… internally, within the party… if she is doing herself a little bit of damage with her stance at the moment.”

Hosking, of course, will know very well from National insiders just how much Barry’s aggressive stance is alienating her colleagues, including some of those who oppose legalisation. She has always been polarising but her crusade against assisted dying has turned the former garden-show host into Roundup on legs in the opinion of many both within and outside Parliament.

The radio host told Mitchell he thought Barry was “giving politicians a bad name” and said: “Even if she doesn’t like [the bill]… there’s not 120 amendments required.”

The North Shore MP’s threat to unleash an avalanche of amendments has been widely seen not only as an attempt to stop the bill or delay its passage, but also to make its criteria so restrictive that it will be more or less unworkable in practice if it does pass.

A big problem with such a diehard stance, of course, is that the bill is not nearly as contentious as the media likes to depict. That much was made clear once again last week when a Colmar-Brunton poll showed 72% of the nation are in favour of assisted dying with only 20% opposed.

That such a substantial majority persists after several years of a vociferous campaign of opposition to Seymour’s bill makes it clear just how popular such a law change would be.

SIMON BRIDGES ADDRESSES THE 83RD ANNUAL NATIONAL PARTY CONFERENCE AT CHRISTCHURCH TOWN HALL. (PHOTO BY KAI SCHWOERER/GETTY IMAGES)

Simon Bridges voted against the bill at both the first and second readings but he must be very aware of the damage Barry and her allies could do to National if the debate continues to run hot in the media until a referendum is held at the next election.

Bridges told Magic Talk radio in June that he was unhappy with NZ First’s call for a referendum before the bill becomes law — which is a condition of the party’s continued support and would be held at the next election alongside one on marijuana for personal use. “I think if we get to the point where we’re having a number of referendums it becomes very distracting from choosing a government to lead this country into the future.”

There will be no referendum, of course, if the bill is defeated at the third reading.

However, if it is passed and requires a plebiscite to become law, the battle will only intensify as opponents mount a desperate rearguard action to defeat it. And that will suck up a lot of oxygen in an election year.

National will consequently be identified in the run-up to the election as the face of fierce opposition to a popular law reform — and that face will inevitably most often be Barry’s.

Like Bridges, Jacinda Ardern is not in favour of a referendum but has said she would vote for one if it was the only way to get the bill over the line. However, she would undoubtedly also prefer not to have the election campaign dominated by two referendums.

The prime minister, who is firmly in favour of assisted dying, reckons a referendum on assisted dying “isn’t required to ensure that the voice of New Zealanders has been heard and to reflect the will of Parliament and the people they represent” — which could be interpreted as a recommendation for MPs to pass the End of Life Choice Bill with enough of a margin to sidestep Winston Peters’ demand for a plebiscite.

The vote at the second reading was a healthy 70-50 in favour but if the nine NZ First MPs vote against the bill at the third reading because a referendum isn’t approved, that majority would become, on current numbers, wafer thin.

However, the changes Seymour has proposed may make his bill palatable enough to some conservative MPs to win their vote and possibly gain sufficient cross-party support to ensure a healthy majority — which means a referendum could be avoided even if NZ First votes against it.

If that happened, the bill could become law before the end of the year.

There are obviously strong incentives for both Labour and National to sort the issue without letting it drag on to the election. Consequently, it’s quite possible that Judith Collins’ switch to the “right side” of the debate will not be the last Road to Damascus experience we see as MPs try to clear the decks before next year’s election campaigning begins.

Poll cross confirms end of life choice support

Philip Patston — Thu, 01 Aug 2019 00:43:21 GMT

A Colmar Brunton poll for TVNZ News on medical assistance in dying cross confirms earlier findings by Horizon Research.

A July 2019 survey of 1000 adults nationwide by Colmar Brunton finds 72% think a person who is terminally or incurably ill should be able to request the assistance of a doctor to end their life.

20% thought they should not be allowed.

Though four months apart, the result is similar to one from Horizon Reseach's survey of 1,341 adults in April 2019 which found assistance for those suffering end-stage terminal illness was 74%.

This compared with 74.9% overall in May 2017.

In the April Horizon 2019 survey

44% strongly supported a law change
30% supported
5% were neutral
5% opposed and
13% strongly opposed
Not were sure 2%

Horizon also found strong support for other measures, now being ruled out of the end of Life Choice bill before Parliament.

These include

Unbearable suffering:

Where such a request has come from a mentally competent patient, 18 years and over, who has irreversible unbearable suffering which may not cause death in the immediate future (e.g. motor neurone disease or some other degenerative or irreversible condition): 65% support, 19% oppose

Advance directives:

Allowing a competent person to write a legally enforceable and binding Advance Directive to allow medical assistance to die should the situations in situations 1 and 2 above occur after the patient becomes mentally incompetent (e.g. with severe brain injury): 66% support,19% oppose

Advanced dementia:

Legalising such a request for medically assisted death by Advance Directive, when a person is suffering from severely advanced dementia: 65% support, 20% oppose.

Comments on this survey result are welcome at Horizon Poll's Facebook page.

David Seymour narrows euthanasia bill to only cover patients with 6 months to live

Philip Patston — Wed, 31 Jul 2019 22:56:11 GMT

Source: Stuff

David Seymour has successfully narrowed his End of Life Choice Bill to only allow assisted dying for terminal patients.

ABIGAIL DOUGHERTY/STUFF

This amendment, which Seymour himself disagrees with, is key to keeping the support of the Green Party and several other MPs for a third reading.

The bill is currently in the Committee of the Whole House Stage, where it could stay for weeks if not months being debated clause-by-clause, before finally going to a third reading debate - and possibly a referendum.

On Wednesday evening during its first committee session, part one of the bill was examined, which includes the definition of who is eligible to request assisted dying.

His amendment passed 74 to 44.

Louisa Wall breaks down in euthanasia speech over personal experience in family
The Labour MP said a family member had a terminal illness, and providing choice is incredibly empowering.

Seymour sought to narrow the bill during its 16-month select committee process but this was not possible as the committee had severe disagreements with how to deal with the bill.

ACT Party leader David Seymour has narrowed his euthanasia bill to only cover those with a terminal illness.

His amendment narrows the bill to only allow a person with "a terminal illness that is likely to end the person's life within six months" to request assisted dying, or euthanasia. The first version of the bill also allowed for a person with "a grievous and irremediable medical condition" to request assisted dying, leading to stern opposition from disability groups who said the bill would allow the disabled to be coerced into death.

Terminal illness is not the only criterion: the patient must also be capable of understanding the decision made and be in a state "of irreversible decline in capability".

Seymour's full suite of amendments - not all of which have passed yet - will set out many other elements of the bill, including the need for two doctors independent of each other to confirm the terminal diagnosis.

The bill passed second reading 70 votes to 50. It is a conscience issue for National and Labour MPs, meaning they are able to vote independently. Indeed, some of the most severe divides on the bill are within the National Party.

Several MPs spoke against the bill, including former speaker David Carter.

"I will oppose this legislation, and I'll oppose it for one significant reason: I cannot be assured that there won't be some elderly person who is coerced into accepting assisted dying," Carter said.

Seymour said there was not evidence of any undetectable coercion from around the world.

"When we look around the world we don't find evidence of it, and, second of all, I don't believe that it's a standard that people apply to other aspects of law. They certainly don't apply it to any of the other medical decisions that people make, and if they did the entire field of medicine would be unworkable."

He said the progress with the bill was very encouraging."The critical change other MPs have asked for has been made, and we've made very good progress.

"If we can pass a part of the bill every member's night then we will be done in September - October or thereabouts."

Green and NZ First MPs are all whipped into supporting the bill provided several amendments.

The Greens sought the narrowing, while NZ First will seek a referendum to be added into the bill.

That decision will not be made until the last stage of the Committee of the Whole House, likely some time away.

Seymour Releases Amendments to the End of Life Choice Bill

Philip Patston — Tue, 30 Jul 2019 21:27:56 GMT

Tuesday, 30 July 2019, 2:17 pm
Press Release: ACT New Zealand

David Seymour, ACT Party Leader and Sponsor of the End of Life Choice Bill, has today released his Supplementary Order Paper containing his amendments to the End of Life Choice Bill.

“Over the last few months I have worked with the Parliamentary Counsel Office and have been provided advice from both the Ministries of Health and Justice. I have also consulted with other Parties and individual MPs, as well as interested parties outside parliament.

“The amendments are formatted as a revision-tracked SOP which clearly shows all amendments I wish to make to the Bill as they would appear in the final legislation if these changes were adopted.

“The End of Life Choice Bill has always been a safe bill as it was designed in line with international Best Practice, contains numerous safeguards and was considered “tightly circumscribed” by the Attorney-General.”

“This SOP has been developed in consultation with Members of Parliament and a range of organisations to allay valid concerns and I am confident that this SOP will receive support from the greatest number of Members of Parliament to ensure a safe and efficient passage of the Bill through Committee of the whole House.”

“I am asking those who support giving compassion and choice to New Zealanders suffering at the end of their life to support these amendments, and New Zealand First’s proposed referendum amendment, while opposing all others. This course of action will ensure a coherent policy outcome and a straightforward Committee of the whole House stage for the bill.

“Some supporters may be disappointed that this SOP will create one of the most conservative assisted dying regimes in the world, but I have listened to concerns from supporters and opponents and have developed them into a high-quality amendment that compliments the Bill as introduced.”

In summary, the major changes are:

To restrict the Bill only to those with a terminal illness, judged by two doctors independent of each other, to be likely to end the person’s life within six months.
Explicitly stating, for the avoidance of all doubt, that a person is not eligible for assisted dying by reason only that the person has a disability of any kind, is suffering from any form of mental illness or mental disorder or is of an advanced age.
To include a more detailed criteria for the assessment of a person’s mental competency.
Explicitly stating that a health practitioner must not initiate a discussion about assisted dying with any patient or suggest to any patient that the person should exercise the option of assisted dying.
Explicitly stating for the avoidance of all doubt that no person can choose to have an assisted death through an expression in an advanced directive, will, contract, or other agreement, or through a welfare guardian acting for that person.
Providing for the eligible person, as long as they retain competency, to be able to change the date and time of the administration of medication for a period of up to six months.

The SOP can be found here.

Plea for ‘honest debate’ of bill

Philip Patston — Thu, 25 Jul 2019 22:14:44 GMT

by Dr Mary Panko
Published: July 26, 2019

COLUMN – Gisborne Herald

In a few days’ time, July 31, the third round of David Seymour’s End of Life Choice Bill will be debated in Parliament and the Committee of the Whole House (CWH) gets to vote on a range of amendments.

There will be a large number of these, some coming from David Seymour himself but most from those opposed to any law change to permit medically-assisted dying. Maggie Barry has already said she plans to raise 120 amendments intending to get the Bill talked out — a method known as filibustering originally introduced by some long-discredited American politician. The filibuster tries to talk a bill to death so that it runs out of Parliamentary debating time.

However, for those who listened to the 20 MPs who spoke on the subject during the second reading (passed by 70 votes to 50), it was clear that there are honestly-held doubts on both sides of the argument — whether the bill goes far enough or if it provides enough safeguards — which make it worthy of an honest debate.

The nearest place to New Zealand which has a similar law is Victoria in Australia and it is worth comparing it to the proposed bill.

Many of its fundamentals are similar; to qualify a patient has to be a resident of the state, aged 18 or over, suffering from terrible pain as a result of a terminal illness and demonstrably not being coerced.

But the Victorian law has at least 68 safeguards, making it the most conservative of all international legislation, some of them pretty strange. Firstly, the patient’s doctor cannot tell them about the potential option of assisted dying. This is a bit like Basil Fawlty’s “Don’t mention the War”. So a dying and suffering patient may be informed about a range of options from palliative care to terminal sedation (oh yes — that’s legal) but not a word about medical-aid-in-dying.

It was argued that if a doctor mentioned this, it could be viewed as coercion. Therefore, people unaware of this possibility will not be permitted to find out about it. Unfortunately, David Seymour appears to think this proviso will persuade one or two additional MPs to vote for the bill and so has scooped up this clause into his own Supplementary Order Paper.

A further level of craziness in Victoria prevents any discussion of assisted dying by phone, text, Internet or, presumably, via carrier pigeon. This means that a dying person living far away from Melbourne and already approved for medical assistance, is barred from discussing any concerns or queries with their doctor. It is to be hoped that we can avoid this problem.

Further, once a patient has been approved for assisted dying in Victoria, the process ceases to be the business of the patient’s doctor or nurse practitioner and is handed over to a pharmacist from the main Melbourne hospital which has been given sole responsibility for dispensing the required lethal drug.

At this point, the dying person is expected to travel to Melbourne to collect the drug and instructions on how to administer it. If the patient is unable to do this, the law says the pharmacist will take it to them. How they can find out that this is necessary, if they wish to avoid federal prosecution for a forbidden discussion, is not clear.

Now, I have the utmost respect for the pharmacy profession as I lectured in a pharmacy department for 20 years, but having to understand and remember a number of complex instructions about a series of drugs which have to be measured and mixed and ingested in a desired sequence is asking too much of most of us. Let alone if we were on the point of death.

Furthermore, pharmacists’ instructions are probably the most ignored of any profession in a day-to-day sense. The pharmacist is also not required to be present while the dying patient attempts to mix and swallow the medication. Will they remember to take the anti-nausea draught first? Will they choke with no one there to help them?

As our MPs prepare to debate this issue again, I ask them to remember that a clear majority of their constituents (two-thirds to three-quarters, according to all reputable scientific opinion polls) want a law change to allow the suffering sick to end their lives painlessly and with dignity.

I also beg them to think compassionately and sensibly about those 2000 New Zealanders who die in unremitting pain every year and allow the tiny proportion who are likely to opt for medical assistance to die, to have the choice this bill would provide.

Dr Mary Panko is President of the End-of-Life Choice Society of New Zealand

Media release from Doctors for End of Life Choice

Philip Patston — Tue, 23 Jul 2019 21:07:33 GMT

A group of doctors who support a law change to allow medically-assisted dying for the terminally ill has accused the New Zealand Medical Association of ignoring international evidence on the issue in favour of “conservative cultural and personal beliefs”.

The group accuses the NZMA board, which opposes the End of Life Choice Bill before Parliament, “of being no more advanced than the ‘anti-vaxers’ or the ‘anti-1080 lobby’, whose beliefs cannot be impinged upon by science, fact or rational thinking.”

The charges are made in a letter to Dr Kate Baddock, chair of the NZMA, signed by Dr Miles Williams, cardiologist of Hastings, and 18 other practising and retired doctors.

He says the 133-year-old NZMA has “been on the wrong side of history in the past, for example in taking conservative, paternalistic and moralistic approaches on issues such as contraception and abortion”.

Dr Williams says that in claiming that no end-of-life choice legislation could be safe, the NZMA is “asserting the superior intellect, insight, analytical powers and judgement of the six members of a small parochial New Zealand board whose collective knowledge and experience of this subject is likely to be limited to discussions around the boardroom table” over that of the judiciaries of countries and states in Europe, the Americas, Canada and Australia, representing more than 150 million people.

In the letter, released shortly before Parliament resumes debate on the bill on July 31, Dr Williams says: “It is important that the New Zealand public is made aware that there is absolutely no contemporary evidence to support any aspect of your opposition to giving the people of this country the right to End of Life Choice.

“It has been successfully implemented in many countries, none of whom have reversed their legislation. It is not unethical, there is no evidence in the literature of coercion, increased suicide rates, distrust of doctors, exploitation of the vulnerable, or of wrongful deaths.

“In all of these countries and states the practice is subject to government-controlled audit. Your dismissal of polls, not only in this country, but of those undertaken in many nations around the world, showing that the majority of people in these countries understand and support EOLC, represents blatant and unapologetic paternalism.”

The NZMA opposed the bill in a submission to the Justice Select Committee in February 2018 and in an interview Dr Baddock gave on TV1’s Breakfast programme on May 22. Dr Williams said “the quality and accuracy” of the statements she made “fell well short of the standards aspired to by the NZMA”.

The NZMA claims to be the country's only pan-professional medical organisation representing the collective interests of all doctors and a strong advocate on medico-political issues.

More information: Dr Miles Williams, 027 240 6127 mwar@xtra.co.nz. The full letter to Dr Baddock is attached.

Released by David Barber on behalf of Doctors for End of Life Choice Tel: 021 072 8760

President’s Report – AGM 22 June 2019 Hamilton

Philip Patston — Sun, 07 Jul 2019 23:24:52 GMT

Kia ora koutou katoa / Greetings to all.

It was my dream that by this time we would be celebrating the successful final passage of the End of Life Choice Act and that I could stand down as President knowing that we had achieved our goal of making assisted dying legal.

In last year’s report I referred to the significant curved ball which Parliament threw us when they agreed to an extension of time for the Justice Select Committee to do its work of hearing as many as possible of the record number of more than 36,000 submitters all told. I had even reduced my ambition to hoping that we would be celebrating the successful passage of the second reading by now, but that has not happened either.

But it will next Wednesday!

Our patience and our aspirations have both been sorely tested in the last year. We have waited and we have lobbied until we are now at the stage where most MPs have taken the phone off the hook (to use a slightly old-fashioned reference).

We have accepted possible compromises as we have seen David Seymour whittle his bill down, first to a half of my original bill by removing the section on Advance Directives, then by another half to exclude grievous and irremediable, but not terminal, conditions.

We haven’t liked the reductions, but we have understood the arithmetic of Parliament. We have been very focussed on getting the requisite votes over 60 in order to get something of what we want passed, rather than nothing achieved at all.

We have also accepted the delays which will occur by virtue of the introduction of a referendum on the Act (as we hope it will be by then), to occur in conjunction with next year’s General Election.

When I have become dispirited from time to time because of these delays and the effort it takes to sustain a campaign over a long period of time, I think of those who have been faithfully battling over this issue for decades. I think especially of the people who first got me involved in it and who are no longer with us: John Murray, Jean Cartmell, and others like Diana Dombroski. You will all remember others too. They worked far longer at promoting assisted dying than I have. I have no right to feel tired!

We have spent the last year lobbying MPs, writing submissions and presenting them, writing blogs, sustaining websites, composing letters to the Editor of every paper in the country, writing opinion pieces, designing flags, t-shirts and stickers, commissioning polls and releasing them at the optimal time, creating petitions for presentation to the local MP, retweeting articles and links, sharing thoughts and overseas experiences on Facebook, and myriad other efforts.

They WILL work.

At the same time, we have fundraised to sustain all these efforts. We have continued to run a voluntary organisation on the smell of an oily rag. There have been no chauffeur-driven cars or wine storage facilities for us! And certainly no $3m+ salary!

I want to thank our National Committee, including our part-time Administrator Peter Cowley, for their unrelenting efforts. They have been a committed and hardworking group of people.

I wish in particular to thank two people who are leaving the National Committee this year because our constitution says they cannot do any more than 8 years’ service. I think they are probably grateful! They are Dr Jack Havill, our Immediate Past President and Carole Sweney, our Secretary. I owe them everything. They have supported me through the trying times and have always been there to give me the benefit of their hard won experience, I could not have done this job without them.

I also want to acknowledge another who is standing down from her National Committee position this year and that is Elizabeth Cronje, our Membership Secretary. Elizabeth was always of the view that what she did in keeping our membership lists up to date and arranging for people to call those whose memberships had lapsed, was of no significance. Quite the contrary – that is how voluntary organisations stay alive and we are very much alive.

To the others on the Committee – Mary Panko as Vice-President now stepping up to be President, David Barber, our indefatigable Newsletter Editor and media wrangler, Pete Cowley, our constant Treasurer as well as our Administrator, we owe enormous thanks. To our regional representatives – Jim Roskvist in Auckland, Dale Lethbridge in Hamilton, Esther Richards in the Bay of Plenty, Linda Kennington in the legendary Kapiti-Horowhenua branch, now stepping up to become our Vice-President, and Stef McKnight in Wellington, who doubles as our graphic artist and visual manager - to all of you, I am hugely grateful. You have kept the fires burning in the regions and provided the structure, including for “branches” such as Christchurch, Taranaki, Napier and Dunedin, which has made people feel connected in. I welcome the arrival of Helen Cartmell as our new Secretary and Teresa Keedwell as the new Kapiti-Horowhenua representative.

Finally, we will have a few more months of debate to get through. I am confident we will get there, despite the best efforts of our minority opposition. Let’s take it to a referendum and get people out to vote for it. We WILL win!

Every good wish to all of you over the next 12 months – keep up the fight!

MARYAN STREET, President, EOLC Society NZ (Inc.)

Please thank our MPs who supported the EOLC Bill's second reading

Philip Patston — Thu, 04 Jul 2019 03:25:51 GMT

MPs are lobbied constantly to support or not support decisions in Parliament.

Please consider sending the MPs who supported the Bill in its second reading a brief email thanking them. It is more effective to send individualised emails rather than blind copying them all.

Click here for a list of supportive MPs and their email addresses. The correct way to address an MP is Hon [firstname] [lastname].

She's helped 150 people end their lives: 'It's been the most rewarding work of my life'

Philip Patston — Sat, 29 Jun 2019 23:25:17 GMT

Stefanie Green didn't enter the medical field thinking she would end up helping Canadians end their lives. In fact, she spent much of the earlier part of her career on the other end of the lifecycle, in the maternity ward, helping mothers give birth.

Speaking at the medical campus of the University of Auckland on Thursday, Green told a gathering of students and clinicians that she had been directly involved in 150 assisted deaths since Canada first passed euthanasia legislation three years ago.

Green's visit coincides with the successful second reading of the End of Life Choice bill and her experiences provide a glimpse at what life might be like for the doctors who will have to carry out the tough job of helping people choose when they'd prefer to die.

Euthanasia in NZ: Meet the doctor who has helped end 150 lives

Philip Patston — Sat, 29 Jun 2019 23:20:42 GMT

The conversation before a patient's last words is what a Canadian clinician finds most interesting about helping someone end their life.

It's a very candid, raw moment that Dr Stefanie Green says connects her with a human being in their final moments.

"Emotionally it's a very interesting conversation because there's really no BS in that moment," Green tells Stuff.

How your MP voted on the End of Life Choice Bill

Philip Patston — Fri, 28 Jun 2019 00:26:15 GMT

Source: NZ Herald

MPs exercised a conscience vote on the End of Life Choice Bill. Photo / Mark Mitchell

Twelve MPs changed their votes between the first and second reading of the End of Life Choice Bill which passed its second reading by 70 votes to 50.

The next debate will be the committee stages, at which many amendments will be proposed, before a final vote is taken on the third reading.

Please consider sending the MPs who supported the Bill in its second reading a brief email thanking them. It is more effective to send individualised emails rather than blind copying them all.

Click here for a list of supportive MPs and their email addresses. The correct way to address an MP is Hon [firstname] [lastname].

* Denotes MPs who have changed their vote since the first reading

SUPPORT - 70

Amy Adams – National - Selwyn

Ginny Andersen – Labour – List

Jacinda Ardern – Labour – Mt Albert

Darroch Ball – NZ First – List

Paula Bennett - National - Upper Harbour

Chris Bishop - National - Hutt South

Tamati Coffey – Labour – Waiariki

Judith Collins* – National – Papakura

Liz Craig – Labour – List

Clare Curran – Labour – Dunedin South

Marama Davidson – Green – List

Kelvin Davis - Labour – Te Tai Tokerau

Matt Doocey – National – Waimakariri

Ruth Dyson – Labour – Port Hills

Paul Eagle – Labour – Rongotai

Kris Faafoi – Labour – Mana

Andrew Falloon – National – Rangitata

Julie Anne Genter - Green – List

Golriz Ghahraman – Green –List

Peeni Henare – Labour – Tamaki Makaurau

Chris Hipkins – Labour – Rimutaka

Brett Hudson – National – List

Gareth Hughes – Green – List

Raymod Huo – Labour – List

Willie Jackson – Labour – List

Shane Jones – NZ First – List

Nikki Kaye – National – Auckland Central

Matt King – National – Northland

Barbara Kuriger – National - Taranaki-King Country

Iain Lees-Galloway – Labour – Palmerston North

Andrew Little – Labour – List

Jan Logie – Green – List

Marja Lubeck – Labour – List

Jo Luxton – Labour – List

Nanaia Mahuta – Labour – Hauraki-Waikato

Trevor Mallard – Labour – List

Jenny Marcroft – NZ First – List

Ron Mark – NZ First – List

Tracey Martin – NZ First – List

Kieran McAnulty – Labour – List

Clayton Mitchell – NZ First - List

Mark Mitchell – National – Rodney

Stuart Nash – Labour – Napier

Greg O'Connor – Labour – Ohariu

David Parker – Labour – List

Mark Patterson – NZ First – List

Winston Peters - NZ First – List

Willow-Jean Prime – Labour – List

Priyanca Radhakrishnan – Labour – List

Grant Robertson – Labour – Wellington Central

Jami-Lee Ross – Independent – Botany

Eugenie Sage – Green – List

Carmel Sepuloni – Labour – Kelston

David Seymour – Act – Epsom

James Shaw – Green – List

Scott Simpson – National – Coromandel

Stuart Smith – National – Kaikoura

Erica Stanford – National – East Coast Bays

Chloe Swarbrick – Green – List

Fletcher Tabuteau – NZ First – List

Jan Tinetti – Labour – List

Tim van de Molen – National – Waikato

Louisa Wall – Labour – Manurewa

Angie Warren-Clark – Labour – List

Duncan Webb – Labour – Christchurch Central

Poto Williams* – Labour – Christchurch East

Nicola Willis – National – List

Megan Woods – Labour - Wigram

Jian Yang – National – List

Lawrence Yule* - National- Tukituki

OPPOSE 50

Kiritapu Allan*- Labour - List

Kanwaljit Singh Bakshi - National – List

Maggie Barry – National – North Shore

Andrew Bayly – National – Hunua

David Bennett - National – Hamilton East

Dan Bidois – National - Northcote

Simon Bridges – National – Tauranga

Simeon Brown – National – Pakuranga

Gerry Brownlee – National – Ilam

David Carter – National – List

David Clark – Labour – Dunedin North

Jacquie Dean – National – Waitaki

Sarah Dowie – National – Invercargill

Paulo Garcia – National - List

Paul Goldsmith – National – List

Nathan Guy* - National - Otaki

Joanne Hayes – National – List

Harete Hipango* - National - Whanganui

Anahila Kanongata'aSuisuiki – Labour – List

Denise Lee – National – Maungakiekie

Melissa Lee – National – List

Agnes Loheni – National - List

Tim Macindoe – National – Hamilton West

Todd McClay – National – Rotorua

Ian McKelvie – National – Rangitikei

Todd Muller – National – Bay of Plenty

Alfred Ngaro – National – List

Damien O'Connor – Labour – West Coast

Simon O'Connor – National – Tamaki

Parmjeet Parmar – National – List

Chris Penk – National – Helensville

Maureen Pugh – National - List

Shane Reti – National – Whangarei

Adrian Rurawhe* - Labour – Te Tai Hauauru

Deborah Russell* - Labour – New Lynn

Jenny Salesa – Labour – Manukau East

Alastair Scott – National – Wairarapa

Aupito William Sio – Labour – Mangere

Nick Smith – National – Nelson

Jamie Strange – Labour – List

Rino Tirakatene – Labour – Te Tai Tonga

Anne Tolley* - National - East Coast

Phil Twyford – Labour – Te Atatu

Louise Upston – National – Taupo

Nicky Wagner – National – List

Hamish Walker* - National – Clutha-Southland

Meka Whaitiri* - Labour – Ikaroa Rawhiti

Michael Wood* - Labour – Mt Roskill

Michael Woodhouse – National – List

Jonathan Young – National – New Plymouth

David Seymour's euthanasia win will have opponents scrambling

Philip Patston — Thu, 27 Jun 2019 22:41:55 GMT

by Graham Adams / 27 June, 2019

Opinion | Source: Noted

Last night, David Seymour’s End of Life Choice Bill took a step closer to becoming law. Photo/Getty.

The healthy majority for the End of Life Choice Bill coming so soon after Victoria’s law passed will ring alarm bells for opponents on both sides of the Tasman.

Last week, a quarter of Australia’s population became eligible for an assisted death if they are terminally ill after the implementation of Victoria’s Voluntary Assisted Dying Act. And last night, on this side of the Tasman, David Seymour’s End of Life Choice Bill took a step closer to becoming law.

The bill passed its second reading with a clear margin — 70-50. It was a slimmer majority than at the first reading in December 2017 — which passed 76-44 — but it is an extraordinary result given the extensive campaign mounted against it over the past 18 months.

The loose coalition of religious and quasi-religious groups which spearheaded the offensive to kill the bill has good reason to be worried about the outcome. There is a real prospect of a domino effect across Australia and New Zealand.

Opponents fear that now Victoria’s act is in operation and many of the practical details of how it will be implemented have been worked out, advocates and voters across Australia and New Zealand will be emboldened and push even more strongly for changes in their jurisdictions.

Assisted dying campaigner Dr Philip Nitschke described the knock-on effect of Victoria’s law change in Australia: “It will put a lot of pressure on the other state Parliaments to pass legislation. You can’t have people in NSW pressing their noses against the glass saying, ‘How come Victorians have got this choice and we don’t?’.”

The effect will reverberate across the Tasman too as the debate continues in New Zealand in the lead-up to the third reading. Many New Zealanders will also think: “If Victorians have this choice, why not us?”

Opponents often try to illustrate the dangers of assisted dying by using examples from faraway countries like Belgium and The Netherlands with very different cultures to our own, but Victoria is very close to home. And more than 80,000 New Zealand-born expats live there. Those who have Australian citizenship or permanent residency, and who have lived in the state for a year, are now eligible for an assisted death if they are terminally ill.

Opponents — particularly the Catholic church — can’t afford to allow another defeat in New Zealand or Australia, and Seymour’s bill passing its second reading means their alarm bells will be jangling very loudly.

That rising level of alarm was evident in Maggie Barry’s advance warning a few days ago that she intends to introduce around 120 amendments when the bill is debated in the Committee of the Whole House. She had obviously counted heads and knew it would easily pass at its second reading — even though she asserted: “What I can say with certainty is that the gap is extremely narrow.”

Her proposed avalanche of amendments is widely viewed as an attempt to filibuster as much as she can — perhaps in the hope that the bill won’t get through Parliament in time for it to be put to a binding referendum at next year’s election.

David Seymour told NOTED he recognises that as a possible “danger” but he doesn’t believe it will be a viable strategy in practice: “Opponents will find it much more difficult than they think to keep it going that long.”

However, even if Barry’s tactics don’t succeed in warding off a referendum next year, or killing it at the third reading, she will be hoping to make the bill so restrictive that it will be very difficult for the dying to access its provisions — which is a criticism that has already been made of Victoria’s legislation, which has 68 safeguards.

Now that advocates are wise to that tactic, however, they are less likely to settle for the same in New Zealand, or in the Australian states where activists are pushing hard for a law change.

Western Australia isn’t far behind New Zealand. A government bill is scheduled to be introduced in August after a cross-party parliamentary inquiry strongly recommended in 2018 that one be introduced — and the eligibility criteria and conditions the MPs proposed in their report look very much like those of the bill Seymour placed in Parliament’s biscuit tin in 2015.

A bill similar to Western Australia’s will be tabled in New South Wales, probably by year’s end. Tasmania’s Parliament will also vote on the issue in 2019 with the legislation having support in principle from both Houses.

Queensland and South Australia are both running inquiries into end-of-life choices and there is a renewed push to allow the territories of ACT and NT to determine their own assisted dying laws (after that right was removed from the Northern Territory in 1997 to quash its pioneering law three years earlier).

While public support in New Zealand has run for years at more than 70 per cent, in Australia support in polls has recently come close to 90 per cent, according to an ABC Vote Compass poll of 450,479 respondents taken before the federal elections in May — which makes opposition by Australian MPs look completely out of touch with their electors.

In the wake of Seymour’s parliamentary success, New Zealanders can expect to see a lot more of the kind of tactics opponents used in the long run-up to Wednesday’s vote — including slick video campaigns, newspaper ads and plain old-fashioned scaremongering — but at an even higher pitch.

Opponents are going to be in a bind, however. Much of their opposition to Seymour’s bill over the two years since it was plucked from the ballot in June 2017 has centred around the clauses allowing eligibility to those with a “grievous and irremediable medical condition” who suffer from “an advanced state of irreversible decline in capability”.

The Catholic church claimed last year that these clauses could include those with chronic conditions such as arthritis, asthma and gluten intolerance as well as the disabled. It was an outrageous and completely erroneous interpretation of the bill but such scare tactics were deployed so relentlessly that last December Seymour proposed — albeit reluctantly — that the “grievous and irremediable” clause be removed.

He recommended restricting eligibility to the terminally ill with six months or less to live (or 12 months for those with a neuro-degenerative disease) as well as adding the express rider that disability or mental illness alone would not qualify anyone for an assisted death.

Seymour’s unexpected move to restrict the terms of eligibility put arch-opponent Maggie Barry into an obvious flap. It was immediately clear to her that in one fell swoop the Act MP had dramatically shifted the goal-posts and the wind could easily turn sharply against her and other prominent opponents — including Disability Rights Commissioner Paula Tesoriero, who has argued that the disabled are at risk of being forced into an assisted death.

Consequently, Barry was quick to point out that the bill was no longer Seymour’s property, and any changes he might suggest are only recommendations. It is true that he is technically now only a passenger watching his own bill’s progress but, unfortunately for Barry, as its sponsor he has a lot of moral authority over how it is framed.

The other obvious bind that opponents will find themselves in now the bill has passed its second reading is Seymour’s proposed amendment for a referendum at the next election before it becomes law — a condition that NZ First has placed on its continued support.

Any MP who doesn’t vote for that amendment risks looking very undemocratic, to say the least, given that a substantial and consistent majority of New Zealanders have wanted a law change to allow some form of assisted dying for more than 20 years.

Politicians might well find that the public are increasingly intolerant of MPs who won’t agree to a referendum — especially once its scope is restricted to only the terminally ill, and disability and mental illness are explicitly ruled out as grounds for eligibility, as seems likely.

If opponents’ major objections are answered — in particular by removing the “grievous and irremediable” clause — why would they go on thwarting what the public have so clearly demanded for a very long time?

Victory! EOLC Bill passes Second Reading

Philip Patston — Thu, 27 Jun 2019 03:24:36 GMT

We must give ourselves a couple of days to celebrate and then get ready for the next round.

Firstly, my deepest thanks to all the people who worked so hard – especially Maryan Street and David Seymour, without whom we would not have reached this position. But in addition, so many people – members and supporters, put in an enormous effort and then shared their joy with us online since the vote. How wonderful it was to read your comments and I’m sorry I could not reply to everyone who sent in emails.

Facing the fight from here, we must keep up the struggle to get a law passed that will be functional and provide relief to those who are dying. We must keep watching the situation in Victoria where some of their legal absurdities are just emerging – it now appears that a doctor could be accused of a federal crime if they discuss Assisted Dying via the phone or Internet with a patient they are already advising! While this is very unlikely, it will worry some doctors before this situation can be resolved. Then there will be the filibustering of our opponents to contend with.

Many other barriers raised in the next few months but each one we can confront if we keep working together. We will be resilient and continue our successes.

Dr Mary Panko
President EOLC Society

Euthanasia bill passes second hurdle, but huge challenges remain

Philip Patston — Thu, 27 Jun 2019 03:16:37 GMT

by Henry Cooke | Source: Stuff

OPINION: David Seymour and other backers of assisted dying will be celebrating after his long-fought End of Life Choice Bill made it through its second reading on Wednesday night.

Seymour's bill passed by 70 votes to 50, a slimmer margin than it did at first reading in late 2017, but well above the 61 votes required.

The vote followed 20 emotive speeches from MPs, many of whom mentioned close ones they had seen die in painful ways.

KEVIN STENT/STUFF David Seymour will be celebrating tonight but a huge fight remains.

Labour and National MPs were allowed to vote according to conscience, while NZ First and Green MPs all voted in support as a bloc.

The victory will frustrate the strong lobby which has campaigned relentlessly against the bill over its marathon legislative process, a lobby with unlikely bedfellows such as former Prime Minister Bill English and Human Rights lawyer Deborah Manning.u

But the real fight is still to come. Before the bill can pass its third reading and become law, almost everyone involved agrees that it will need serious amending - including Seymour himself. And that's before we even get started on a possible referendum.

That is because the Justice select committee that considered the bill had two members so bitterly against it the committee didn't manage to make any major changes, despite taking 16 months and receiving 38,000 submissions. It was one of the biggest failures of a select committee in living memory, and the frustration of member Greg O'Connor was apparent as he thundered through his speech in support.

So the various amendments Seymour needs to make for the bill to pass will not be implemented in the tidy private process of the select committee, but in the messy and extremely public committee of the whole house, which takes place before the third reading.

Firstly, the Green Party and several other MPs want the bill to be narrowed to only cover those with terminal illness likely to die within six months - in its current state it also covers those with a "grievous and irremediable medical condition," a clause that has particularly worried disability advocates.

This narrowing is likely to pass, but whether it ends up going far enough to keep enough people on board will be hard to tell: It's very hard for a party like the Greens to ignore outrage from the disability community.

Then there is NZ First, which has agreed to support the bill if a referendum is attached.

Seymour has agreed to support the referendum, but 61 votes for the amendment will be needed, and many MPs might not be keen on such a controversial issue being tacked on to the 2020 election. Those who are deeply against the bill might have the most reason, as most polling shows a referendum would likely see the bill become law.

It's quite unclear what would happen with NZ First's nine votes if the referendum is not inserted - MPs have differing ideas, and no NZ First MP made a speech on Wednesday night. If all nine voted against the bill it would almost definitely fail. But if the caucus decided to abstain, or allowed its MPs to vote their conscience, the bill could still have a strong shot.

The committee stage will also allow deeply opposed MPs many opportunities to frustrate the process, seeking to pass amendments that nullify the bill or make it so loose as to lose votes.

This is not the US Senate and the Speaker can stop too much mischief-making. But since the bill will only progress during fortnightly members' nights, it could still take a long while.

Conscience votes are rare in New Zealand, but are needed to deal with the extreme divisions within parties on some issues.

Their rarity and the strong emotions they can rouse mean they are embedded deeply into history. Short-term political gain can lead to long-term historical shame. The words of those who opposed Homosexual Law Reform followed them for decades. The debate that MPs will have over the following months will follow them too.

* Originally the vote was declared by the Speaker as a 70-51 result, but was later corrected to 70-50.

Stuff

Lecretia would have been pleased with the End of Life Choice Bill

Philip Patston — Sun, 23 Jun 2019 02:53:04 GMT

by Matt Vickers | Source: Stuff

Assisted death advocate Matt Vickers, former prime minister Sir Bill English and wife Dr Mary English fronted a parliamentary hearing on the End of Life Choice Bill in August.

OPINION: This week MPs will decide whether the End of Life Choice Bill will pass second reading. It has been over four years since my late wife Lecretia Seales pursued a choice about how she died. It has taken a long time and a lot of work to get to this point.

Lecretia was a law reformer and well respected amongst the legal community. She worked for two prime ministers: Sir John Key, as a justice advisor, and Sir Geoffrey Palmer QC, as a senior legal advisor at the Law Commission. She knew exactly what she was asking for, and its legal implications, and she would be pleased with the End of Life Choice Bill, which has been crafted with the assistance of lawyers who acted for Lecretia in Seales v Attorney-General.

Those lawyers have been steeped in this issue for years and have a deep understanding of how the laws work overseas. They are this country's legal experts on this issue. And despite misrepresentations from opponents, this bill stands up as one of the best examples of all of them, tailored to the needs of New Zealanders.

It is smart, robust, and evidence-based law.

MATT VICKERS | Matt Vickers and Lecretia Seales in 2010.

Palliative care is a wonderful thing, but like medicine, it is not perfect. Justice David Collins, in his ruling on Lecretia's case, accepted this fact based on the evidence presented by both parties. So the question becomes: what do we do if we know that palliative care cannot deal with all suffering? Do we just accept that some people will suffer awful deaths, turn away from them, and decide that those people are just unlucky? Or do we listen to them, show compassion, and allow those people to have a choice about how they die?

The End of Life Choice Bill offers people that choice, which I believe is the only humane thing to do. Next month, at a memorial lecture I have organised in my wife's name, a philosophy professor specialising in ethics from Harvard University will visit New Zealand to discuss the moral permissibility of offering these sorts of choices.

Should the bill pass second reading, we will see amendments proposed by MPs for tightening the wording and the criteria. In fact, the Ministries of Justice and Health have already been providing input to amendments to address all the concerns of opponents.

MONIQUE FORD/STUFF | Matt Vickers submits on the End of Life Choice Bill at a select committee hearing in August.

The sponsor's amendments will restrict access to those that are terminally ill, and in an advanced state of decline, and who are suffering unbearably. Despite the claims of opponents, the bill will not allow people to access assisted dying on the basis of a disability alone. No one wants that. I certainly don't support that, and neither would Lecretia. It will bring the law into line with the one that just came into effect in Victoria, Australia, which is regarded as the most rigorous assisted dying regime in the world.

New Zealanders deserve to see the final bill, what the criteria would be, and who would be affected. So let's support the bill, get to a final drafting, and then talk about what it will mean before a final vote later this year.

SUPPLIED | Matt Vickers is looking forward to the second vote on the End of Life Choice Bill next week.

If the bill was voted down at second reading, that would be MPs denying New Zealanders an opportunity to see the bill's final wording, which would be a terrible disservice to the public, and to Lecretia's supporters, who have worked incredibly hard to see this issue considered after decades of parliamentary inaction. Support for assisted dying runs anywhere between 65 and 75 per cent, depending on who is doing the polling.

Our elected representatives know assisted dying is well supported by their constituents and therefore have a duty to give this bill the best chance of success.

MPs that vote yes on Wednesday are not only voting in support of assisted dying, but in support of representative democracy itself.

I look forward to applauding them.

Sunday Star Times

The Nation: Canadian euthanasia practitioner Stefanie Green

Philip Patston — Sat, 22 Jun 2019 03:04:27 GMT

Press Release: The Nation

On Newshub Nation: Simon Shepherd interviews Canadian euthanasia practitioner Dr Stefanie Green.

The euthanasia debate is progressing, with the End of Life Choice Bill expected to have its second reading in Parliament on Wednesday. A similar bill was passed in Canada in 2016 - and it's estimated about 8000 people have had a medically assisted death there. Dr Stefanie Green is President of the Canadian association of doctors and nurses who provide euthanasia services.

Dr Stefanie Green: Thanks for having me.

First of all, you’re a doctor, so how do you reconcile pro-euthanasia views with the spirit of being a doctor?

I think it’s absolutely consistent. No matter what we say at our medical school interviews, most of us go into medicine to help people, and this is another form of helping people at a really vulnerable and terrible time in their lives.

So what do you say to the New Zealand Medical Association’s stance that they say euthanasia in any form is unethical?

I think that’s naïve, to be perfectly honest. I think that when someone is suffering intolerably at the end of their life and we have a legalised medical service that allows for us to help them in that moment. When a competent adult asks me to help them, I feel like I’m helping them by doing that.

And you have done that roughly 150 times, you personally have been involved in medically assisted death, or MAID, as you call it, in Canada, haven’t you?

Yes, I’ve had the privilege of helping 150 people end their life.

Is it a privilege, is it?

Oh, it’s a sincere privilege. It’s a very intimate time for someone. It’s a privilege to witness them through that journey, to support them through that journey, to offer them a care that they’re desperate for and to be able to grant them that and to help them do it in a very comfortable way, it’s a huge privilege.

Does this normalise the process? Does it normalise the idea of assisted suicide?

I don’t think ‘normalises’ is the right word. I think accepting it as another form of care at the end of life, as another end-of-life care option. There are many, and it is only one, and only 1.5 per cent of all Canadians’ deaths are chosen to be in this way. It’s a very small number still, but I think it’s important.

Let’s talk about your experience. In the people that you have assisted, has it always been peaceful?

In the people that I have assisted, it’s always been peaceful. Absolutely, because it’s a controlled procedure that I am there to make peaceful.

And how long does it take?

Well, the majority of assisted deaths in Canada are actually by clinician administered medication, which is what I’m doing. And so, technically, from the initial administration to the end of the procedure and the end of heartbeat, it’s, on average, about 10 minutes.

Most of it is clinician assisted. Do people actually self-medicate?

There is the option in Canada legally to self-medicate. We’ve had very very few – I’d say probably under 20 cases in 8000. I’ve been involved in one. It takes a little bit longer. It’s also peaceful, but it’s a different process.

Because there is that concern here that it doesn’t always go according to plan and that the death is not peaceful. Have you come across this at all?

I have actually not come across that at all. The protocols in Canada we use are based on the Dutch protocols. They’re very very effective. We lobbied very hard with my group CAMAP to have the proper medications available so that we could have a lesser time to dying and a more comfortable experience, and so it’s been good.

Okay. Why shouldn’t high quality palliative care be the answer to people who are at the end of their life?

High quality palliative care is essential. I think that we need to lobby for that. I’m all in favour of that. I’m very lucky where I live my work is very well integrated with palliative care teams. It’s essential for our patients to have that. But we all know that palliative care cannot address every single event, and there are patients that suffer at the end that palliative care cannot help.

Right, so it’s true that palliative care cannot ease every point of suffering.

Of course not.

Okay.

Every palliative care doctor will tell you that, and if they don’t say so, they’re being disingenuous.

At what point do you say you can’t help someone? If someone comes to you and they have very poor quality of life, but it’s not an irreversible disease or symptom, what do you say to them?

That’s probably the hardest thing of what I do. We have very strict eligibility criteria in Canada that must be rigorously found to be true, and if somebody comes to me suffering at the end of their life with a chronic disease or a chronic pain that they’ve had for many years but they don’t meet all of our criteria, I can’t help them. That doesn’t mean they’re not suffering. That doesn’t mean I don’t want to, but I have to work within the law and so I need to explain to them that I believe what’s happening to them is horrible, but I’m not legally allowed to help them, and I have to help them try and find other resources.

You’re the president of the Association of the Doctors and Nurses that help provide these services. Do your members need counselling?

We offer support systems to our members. There’s a number of different regional resiliency programmes. We do find, though, and early Canadian data is showing a little bit to our surprise that the attitudes and experiences of people providing this care has actually been fairly positive. People find this work incredibly rewarding. Patients are incredibly grateful for the care, and most people actually don’t need that support. It is available for them. We encourage a lot of self-care, a lot of support within collegial groups, and we have a national group where we’re in touch with each other all the time to support each other, which is essential, but it’s been well absorbed.

Because the New Zealand Medical Association here has a stance against euthanasia, I mean, did this issue at the time of debate when it’s coming through drive a wedge through the medical profession?

I don’t think so. I think that the Canadian Medical Association has had a neutral opinion about this in an effort to support all 85,000 members of our association, because there is, obviously, a wide variety, but I don’t think there was a wedge. I think there was a bit of a fear at the beginning. A lot of physicians didn’t understand what this was or how to do it. A little bit scared to step into that space. The very few who did step forward banded together very quickly in our organisation, and we’ve built a really strong network of support for each other. So I don’t think ‘wedge’ is the right word.

It’s three years on. No law is perfect, I guess. Do you believe that Canada’s law could work better?

Actually, I have to say that Canada’s law is working really really well. There’s obviously people on both sides of the debate saying it’s not liberal enough or it’s already too restrictive. There’s lots of debate. But it’s quite rigorous. The eligibility criteria have stood for three years. There’s no rollback, there’s no location locally, provincially or nationally looking to expand that. It’s holding well. I think that there’s a number of safeguards in place that are holding, and I think there’s absolutely no evidence of any sort of misuse. There’s been no charge of any clinician.

Okay, so you say that the safeguards are in place. In particular, what are the safeguards that you support that are in place?

There’s a number of safeguards in place. Whether I support them or not we could talk about another day. But a patient needs to give consent both previously when they have a written consent. They actually need to give consent at the moment of the death. So it has to be the patient themselves. There’s a 10-day waiting period reflective to think about their decision, to discuss it with family and have other opinions involved. There’s lots of safeguards. There’s many more.

You talked before about the legislation being reasonably stable, but there is debate in Canada at the moment about whether to increase it, and there have been reports on whether mature minors should be accessible.

I’m really glad you asked me. This is a misrepresentation of the facts of Canada. There is absolutely, in no jurisdiction in Canada, any current move to expand our eligibility criteria. Let me make that very very clear. Including mature minors. So if you just give me exactly 30 seconds, it used to be that there was a blanket ban on assisted dying in Canada. The highest court in our country carved out an exception where that could be legalised, and then the government legislated a law which is more restrictive than that, which is our current law for MAID in Canada. There is current debate. There are two court challenges challenging the restricted law to put it back to the High Court’s definition of criteria, and whether that does or doesn’t happen, it was yet to be seen. But other than that, there’s no expansion of any criteria. The issue of immature minors, which has been raised in your media, is an issue which has been discussed well before our law, during the law, and currently there’s a group of academics that have written a report about the issue of whether… Actually, the report is a collection of international data about the issue of mature minors and euthanasia. It makes no recommendation to government, and there’s no government anywhere considering expanding our law to include mature minors at this time.

So you believe that this has been misrepresented by anti-euthanasia advocates over here?

Absolutely.

Okay. What about our law? Have you had any experience or have you looked at our law and do you see any problems with it, our proposed law?

I’m not going to comment on the New Zealand legislation that’s been proposed. I think that there is a lot of similarities, from what I’ve read, to the Canadian law. There’s also some significant differences – most significantly, I believe that there’s going to be a move towards making it restricted to terminal illness with the prognosis of six months. It’s very very different to Canada.

In Canada, it’s what?

In Canada, one of the criteria is that the natural death of the patient must be in what’s called the reasonably foreseeable future. And that is a bit of a vague term that required some time to get used to interpreting. We now have a better idea, but there’s nowhere about terminal illness or a particular time.

Would it make it easier for you if you had those kinds of restrictions that are proposed here?

No, I don’t think so. I think that would be… I think the idea of terminal illness in six months is very very restrictive and really cuts out a significant group of people that are suffering intolerably.

And those kinds of prognoses are often wrong, aren’t they?

They are. We’re not very good at that.

Okay. What about a couple of other issues that get raised here. What about the issue of coercion, that somebody is vulnerable and in a vulnerable state and they don’t want to be a burden to their family and are coerced into electing this? Have you seen that?

I actually haven’t seen that at all. I think it’s a bit condescending to people to tell them that they can’t make up their own mind. It’s part of my job to ensure that there is no coercion – both external or obvious coercion or even subtle coercion. And I always speak to patients privately and alone and have a conversation with them. I take that very very seriously. But every physician every day in their practice talks to patients about capacity and consent and coercion. They don’t use those words, but that’s exactly what they’re doing. So when people tell me that I’m challenged to do that properly, I think that’s a little bit insulting, and I certainly do know how to do my job.

Okay, and one last question. So since it’s been in place, about 8000 people up to the end of last year have taken advantage of this legislation. Has there been an increase, a jump in numbers as they years have gone past? You’re talking about 1.5 per cent of the deaths in Canada being assisted. Is that a jump? Has it been going up?

Well, it’s been going up because basically to use kind of a vulgar analogy, there’s a new product in town. It takes time for people to understand it’s available, it’s legal and it’s available in their place and how to access it, so of course the numbers are going to increase slowly over the first couple of years. This is exactly what happened in Europe. The numbers are exactly what we expected in the first couple of years. It’s still very little. It’s still about a third of what’s happening in the Netherlands. I do expect we’re going to see an increase still in Canada. I don’t think we’ve plateaued yet, but we’re getting there.

Okay. Dr Stefanie Green, thank you very much for your time this morning.

Thank you.

Transcript provided by Able. www.able.co.nz

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Media Release: Congrats to Victoria on allowing people the choice to die

Philip Patston — Tue, 18 Jun 2019 22:55:49 GMT

Today marks the coming into effect of Victoria’s Voluntary Assisted Dying Act 2017. From today, Victorians at the end of a terminal illness who meet strict eligibility criteria will be able to access assistance to die.

The End-of-Life Choice Society in New Zealand congratulates the state of Victoria for arriving at the culmination of its process with this legislation.

“Victoria is the first state in Australia to reach this point, but other states look as if they are following,” said Maryan Street, President of the New Zealand End-of-Life Choice Society.

“Their MPs have gone through a very similar lengthy process to ours, with a select committee producing a very good report which recommended the passage of their law, with its 68 safeguards.

“In a week, our MPs will have a chance to vote on the second reading of David Seymour’s End of Life Choice bill. Let’s hope they recognise the 74% of New Zealanders who support or strongly support a law similar to Victoria’s.

“All we want is the choice, when we are in the end stages of a terminal illness, to die on our own terms under lawful and regulated conditions. We don’t prescribe it for everyone – we just want people to have the choice if they meet certain criteria.

“Laws like this can work well and are doing so around the world, including now, in Victoria,” said Maryan Street.

Maine becomes the latest US state to pass EOLC law!

Mon, 17 Jun 2019 00:21:49 GMT

AUGUSTA, Maine (AP) — Maine legalized medically assisted suicide on Wednesday, becoming the eighth state to allow terminally ill people to end their lives with prescribed medication.

Democratic Gov. Janet Mills, who had previously said she was unsure about the bill, signed it in her office.

“It is my hope that this law, while respecting the right to personal liberty, will be used sparingly,” said Mills.

Oregon was the first state to legalize such assistance, in 1997, and it took over a decade for the next state, Washington, to follow suit. While still controversial, assisted suicide legislation is winning increasing acceptance in the United States, and this year at least 18 states considered such measures.

Maine’s measure will allow doctors to prescribe a fatal dose of medication to terminally ill people. It declares that obtaining or administering life-ending medication is not suicide under state law, thereby legalizing the practice often called medically assisted suicide.

The proposal had failed once in a statewide referendum and at least seven previous times in the Legislature. The current measure passed by just one vote in the House and a slim margin in the Senate.

The signing Wednesday was a relief to Mainers such as Staci Fowler, 47, who’s taken on the fight for such laws in honor of her late friend Rebecca VanWormer.

VanWormer, whose breast cancer spread to her bones, had pushed for such a bill in 2015 — two years before she died in 2017.

“This is what she wanted,” said Fowler, an educational consultant in Gardiner. “And now everybody has the option that she didn’t have.”

Maine joins seven other states and Washington, D.C., that have similar laws, according to the Death With Dignity National Center and the Death With Dignity Political Fund. The states are: California, Colorado, Hawaii, Oregon, Vermont, Washington, and New Jersey, whose governor signed the legislation earlier this year.

Montana doesn’t have a specific law on the books, but the state Supreme Court ruled in 2009 that doctors could use a patient’s request for life-ending medication as a defense against criminal charges.

Maine’s population has the oldest median age, and, as in other states, the proposal has exposed divisions that defied party lines.

Supporters, including Democrats and a small group of Republicans who say the legislation is in line with the rugged state’s tradition of individualism, say the terminally ill should have the right to choose how their lives end.

The governor said she believes the law should protect such rights, while also spelling out protections for those “unable to articulate their informed choices.”

She issued an executive order Wednesday calling for the state to swiftly put the law’s protections into place and analyze the law’s impact.

Opponents, meanwhile, have said any assisted suicide legislation puts the terminally ill and individuals with disabilities in danger of abuse, coercion and mistakes. Such groups argue that doctors can be wrong and that government is devaluing life by “turning suicide into a medical option.”

“Do you think the insurance companies will do the right thing or the cheap thing?” said Teresa McCann-Tumidajski, executive director of the Maine Right to Life Committee. “The so-called safeguards are there for the physicians, insurance carriers and lawyers. Not the patient.”

As more states slowly pass similar laws, critics nationwide argue that government should simply never wade into such issues.

“Assisted suicide is a dangerous public policy that puts the most vulnerable people in society at risk for abuse, coercion and mistakes,” said Matt Valliere, Executive Director of Patients Rights Action Fund, an advocacy group. “It also provides profit-driven insurance companies perverse incentives to offer a quick death, rather than costly continuing quality care.”

The law’s Democratic sponsor said the latest language addresses criticism of past efforts that have failed in Maine.

The legislation defines “terminal disease” as one that is incurable and will likely end in death within six months.

The law requires a second opinion by a consulting physician, along with one written and two verbal requests. Physicians would screen patients for conditions that could impair judgment, such as depression.

The law criminalizes coercing someone into requesting life-ending medication, as well as forging a request for life-ending medication.

By MARINA VILLENEUVEJune 13, 2019, AP news USA

https://www.apnews.com/7f0fe9d789294a02852c1669c892f382

Dr Rodney Syme honoured as Member of the Order of Australia

Mon, 17 Jun 2019 00:07:48 GMT

Rodney Syme honoured as Member of the Order of Australia

Tuesday, June 11, 2019

Dr Rodney Syme, a longtime advocate for euthanasia, is being appointed a Member of the Order of Australia for his significant service to social welfare initiatives and law reform.

Dr Syme has been vice-president of Dying with Dignity Victoria since 2007, served as the organisation's president from 1996 to 2007, and prior to that he was the president of the Voluntary Euthanasia Society of Victoria. He played an important role in the Victoria's Voluntary Assisted Dying (VAD) Act 2017 that will go into effect on the 19th of June 2019.

Syme has also been a member and a past board member of the World Federation of Right to Die Societies. The former head of the Austin Repatriation Medical Centre's urology unit is the chair of Your Last Right, which campaigns for law reform on voluntary euthanasia in Australia.

Maine Adopts Death with Dignity

Philip Patston — Wed, 12 Jun 2019 21:46:02 GMT

Source: Death with Dignity

Governor Janet Mills today signed the Maine Death with Dignity Act into law.

With the Governor’s signature, Maine became the 9th jurisdiction to allow people with a terminal illness to die the way they want: without suffering, in peace, and with dignity. Nearly 70 million Americans now live in a state with an assisted dying option.

This victory would not be possible without Val Lovelace, the truly fearless leader of Maine Death with Dignity. Her tireless work with legislators, volunteers, and the media; her testimonies, community presentations, and sleepless nights; and her perseverance above all made the difference.

Val said, “I applaud Governor Mills for signing the Death with Dignity Act into law. I am so proud and grateful to finally be heard by our lawmakers and our Governor on this issue. This is an exceptionally historic day for Maine.”

Culmination of a Long Campaign

The Maine Death with Dignity Act was introduced in the legislature earlier this year as LD 1313 by Representative Patricia Hymanson (D-York), a retired neurologist, with bi-partisan co-sponsorship from both chambers. This was the third session with a similar bill. The bill passed in the House by 73 to 72 and in the Senate by 19 to 16 earlier this month.

A parallel effort Maine Death with Dignity initiated in May 2018 gathered over 72,000 valid signatures and would have taken the question to ballot in 2020 had LD 1313 failed.

We Are Grateful

As we celebrate this momentous day, we also think of Mainers like Eva Thompson and Rebecca VanWormer who advocated for death with dignity until their final days and died fighting for their right to die on their own terms. It is in their honor that we will always remember this day.

Val Lovelace (left) with Eva Thompson after a legislative Committee hearing in April 2017

And it was the Mainers’ and others’ generous contributions, letters and phone calls to legislators, Facebook posts and tweets, signatures on the ballot initiative petition, conversations with loved ones, crossed fingers as we waited for this day in Maine, and more that got us here.

From Maine to California, Washington state to Washington, D.C., Hawaii to Vermont, together we are making progress in bringing death with dignity to all Americans who want the freedom to make their own end-of-life decisions. Thank you for being part of history.

Next Steps

“The Death with Dignity Act is an important step toward providing Maine residents with the autonomy, freedom, and peace of mind that has been a godsend to dying patients in other states,” Val said.. “It’s past time for that here. I look forward to continuing public education and advocacy efforts in Maine. It’s important for people to have correct information about how the law works and who is eligible to qualify.

Like the Oregon law it is based on, the Maine Death with Dignity Act allows qualifying terminally ill adult state residents to receive prescription medication to end their lives in a peaceful and dignified manner. The patient must be competent and deemed by two physicians to be within 6 months of death, the same standard as hospice, and capable of taking the medications themselves. The process entails two oral and one written request witnessed by two people and a lengthy waiting period.

In over 40 years of combined flawless implementation in Oregon, Washington, Vermont, California, Colorado, D.C., the death with dignity option has been used sparingly. In Oregon, fewer than 4 in 1,000 deaths in the state are under the law. A third of those who successfully obtain a prescription opt not to use it.

“Oregon’s pioneering law was carefully implemented and has been working exactly as intended for over two decades,” added Peg Sandeen, our Executive Director. “It is past time for states like Maine to adopt death with dignity.”

Compassion is not a crime: new campaign ‘Acts of Love’ launched by families devastated by ban on assisted dying

Philip Patston — Wed, 22 May 2019 01:28:01 GMT

Source: PoliticsHome

Families across the country who have felt the devastating effects of the blanket ban on assisted dying have come together today (Tuesday 21 May 2019) to launch a new campaign calling for a change in the law.

‘Acts of Love’ is led by Ann Whaley, who was interviewed under caution earlier this year after police were anonymously notified of her plan to accompany her terminally ill husband Geoffrey to Dignitas. Ann is due to meet with the Secretary of State for Justice, David Gauke, next month, whose support for a change in the law was recently revealed (Sunday Express, 19 May 2019). Ann will be urging Mr Gauke to look at the dreadful consequences that the current law on assisted dying is causing for families like hers.

The campaign, comprised of over 30 relatives and friends from across the country, launches as Lord Sumption’s first Reith lecture is broadcast on BBC Radio 4 today. At its recording, Ann asked the former Supreme Court judge for his views on the current law, to which he replied “I think that the law should continue to criminalise assisted suicide, and I think that the law should be broken from time to time… That is an untidy compromise few lawyers would adopt but I don’t believe there’s a moral obligation to obey the law. Ultimately it’s for each person to decide.”

On Thursday, Baroness Molly Meacher, Chair of Dignity in Dying, will be pressing the Minister to accept that when a former Supreme Court Judge suggests that families of dying relatives should break the law, that law is itself broken and needs reform. She will ask what plans the Government has to prepare for legislative change on assisted dying.

Ann has written an open letter to all MPs urging them to listen to the Reith lecture broadcast and to support Acts of Love. Ann said:

“Lord Sumption’s comments show complete unawareness of the reality faced by families like mine. We were fortunate enough to have the money to help Geoffrey get his final wish to die on his own terms, but many in this country are not so lucky. We also had to say goodbye before we were ready as Geoffrey feared he was losing the strength to travel. When the police got involved, our world fell apart. I was made to feel like a criminal for acting out of love and this has spurred me on to launch this campaign with Dignity in Dying.

“I am delighted that David Gauke has agreed to meet me to discuss these issues and I am encouraged by his support for my family’s plight. Compassion is not a crime and the current law cannot be allowed to continue as it is – that is my message to him and to all MPs.”

Sarah Wootton, Chief Executive of Dignity in Dying, said:

“The families behind Acts of Love have all felt the effects of the UK’s cruel and outdated law on assisted dying. Some, like Ann, have been criminalised for acting out of love for a terminally ill relative after the blanket ban on assisted dying forced them to take the law into their own hands. Others did not have the funds or means to act, and instead watched helplessly as a loved one suffered a traumatic death at home or took drastic steps to end their own life. Families should not be put in this agonising position.

“Over 100 million people around the world are covered by laws that take this dilemma out of the hands of loved ones and instead provide dying citizens with choice and compassion alongside robust protection for the rest of society. It is high time the UK followed suit. We are calling on the Justice Secretary to look into the suffering caused by the blanket ban on assisted dying in this country. Until change comes, acts of love will continue to be criminalised and compassion will be punished. If we really care about our dying citizens and their families, there is only one thing to do: fix this broken law.”

New Zealanders have their say on dignity in dying, again

Philip Patston — Tue, 21 May 2019 22:17:29 GMT

by Maryan Street, EOLC President

As MPs cast their vote on the End of Life Choice Bill this month, a fresh Horizon Research poll confirms consistent surveys showing that fewer than one-in-five voters oppose a law change. 74% support end of life choice and only 19 % oppose it.

The research commissioned only last month, clearly reinforces the evidence that a majority of New Zealanders want to allow doctors to help the terminally ill to die painlessly and with dignity.

I am urging our supporters to keep up their efforts to bring these findings to the attention of MPs.

There is evidence some MPs may have been persuaded by the orchestrated numbers making select committee submissions and it is clear that emails opposing the bill have been unrelenting. Clearly this promulgation is far from representative of a strong public sentiment, as shown in yet another poll.

I hope that those MPs who are tending to oppose the bill, will vote for its second reading so that they can hand the final decision to the people in a referendum.

This important issue is very much alive and MPs need to represent the collective will of the people, for the sake of an electorate that consistently supports change, in order to give people the choice to die with dignity.

Will MPs let voters make the call on euthanasia?

Philip Patston — Tue, 21 May 2019 00:45:36 GMT

If David Seymour’s assisted dying bill gets knocked out in Parliament, hopes of a referendum at the 2020 election die with it, writes Graham Adams.

GETTY IMAGES.

Graham Adams | Guest writer | The Spinoff

Opinion

We will soon find out — probably in the next six weeks — which of our MPs believe in participatory democracy and which don’t.

The vote on the second reading of the End of Life Choice Bill had been predicted to take place on May 22 but that now looks unlikely. As David Seymour himself told me: “There are enough bills ahead of us to fill up the May 22 session. That puts us back to either June 19 or June 26, depending on the Budget.”

The result is awaited with bated breath by supporters and opponents, but a delay of a few weeks is insignificant after the tactics mounted by those keen to thwart the bill’s progress. Chief among these was the justice select committee’s extraordinary decision — apparently instigated by assisted dying’s arch-opponent Maggie Barry — to hear everyone who wanted to make an oral submission.

Predictably, the result of this filibuster was that most of the 1350 oral submitters didn’t offer insights that weren’t already in their written submissions but it did successfully keep the committee tied up for several months.

A huge majority of the submissions were against the bill, but the negative publicity emanating from the hearings hasn’t fazed those who were asked their opinion in a Horizon Research poll, published in early May.

It found 74% of New Zealanders believe that if you are mentally competent, and aged 18 or over with an end-stage terminal disease, you should be able to get medical assistance to end your life. Just 19% were opposed.

So after what is now several years of dedicated scaremongering by opponents — including Maggie Barry calling the End of Life Choice Bill a “licence to kill” and Bill English claiming that people will be put “on the euthanasia conveyor belt” — an overwhelming majority of voters still want the right to shave a few days or weeks off the end of their lives if they are terminally ill.

And, as David Seymour noted, these poll results “are consistent with over 20 years of public polls on assisted dying in New Zealand conducted time and time again by reputable polling companies”.

It is clear that most New Zealanders want some form of assisted dying to be legalised. Unfortunately, many supporters also believe they don’t have to pay too much attention to which way their MPs will vote at a second reading because they will be able to have their say in a referendum scheduled at the next election.

But that’s simply not true. At the moment, there is no referendum officially scheduled or guaranteed. In fact, if the End of Life Choice Bill is defeated in the House at its second or third readings, that’s the end of the process.

ACT LEADER DAVID SEYMOUR. PHOTO BY HAGEN HOPKINS/GETTY IMAGES

As David Seymour told me when asked whether there was a fallback provision for a referendum even if his bill failed: “Sadly all three votes [in Parliament] are sudden death. If we don’t get a majority at second reading, it’s all over.”

Winston Peters has made a referendum a condition of his party’s continued support for the passage of the bill and consequently Seymour has suggested amending it to include that requirement (as well as narrowing its eligibility criteria to apply only to the terminally ill to satisfy the Greens and other MPs who want narrower access).

NZ First MP Shane Jones made his party’s case for putting it to the people clearly and cogently on TVNZ’s Breakfast show in April. He said that he was brought up as an Anglican — even if he’s “not a very good one” — and implied that he personally found the topic of assisted dying uncomfortable as “a tapu sort of subject”. Nevertheless, he, and NZ First, believe that “temporary occupants in Parliament should hand it over to all New Zealanders who should decide”.

But this, of course, only comes into play if Seymour gets 61 votes to push his bill over the line at both its second and third readings.

At the End of Life Choice Bill’s first reading in December 2017, a big majority of MPs — 76-44 — voted to send it to the justice select committee. It was understood then that some MPs voted in favour simply to give the committee the chance to assess it, without making any commitment to further support it at later readings.

But, in April, the select committee recommended only technical changes and passed its responsibilities back to the Committee of the Whole House.

So it’s hard to see why any MP who thought it was a good idea for a select committee to review the bill at the first reading wouldn’t vote for it again at a second reading because it is the same bill being presented.

Seymour agrees with that logic but says: “However, some MPs will, of course, say, ‘Well, the changes didn’t happen at select committee so why should I hang out until the Committee of the Whole House?’”

It’s obviously going to be complicated and time-consuming as MPs do the detailed work in refining the bill that the select committee would normally be expected to have done and some antagonists are using that prospect as a reason to kill the bill as early as possible.

DefendNZ has suggested its followers contact MPs to warn them there will be lengthy debates over amendments and to “expect the conversations to get longer and much more intense… Should the bill pass its second reading, the Committee of the Whole House stage will likely be extremely lengthy, as dozens of MPs try to fix the bill.”

It’s hard to read this any other way than asking MPs: “Why not guarantee yourself an easier life by simply voting it down at the second reading?”

However, it would be outrageous if the 15 months of work that select committee MPs have put into the bill so far — including hearing oral submissions from 1350 individuals and organisations at 42 public hearings in 14 cities and towns across the country — was simply ignored for expediency’s sake.

If anything is on a conveyor belt, it should be this bill’s progress to a referendum, given the overwhelming public support for it.

Opponents, however, are very keen to prevent the bill going to a referendum despite crowing for months that 90.2 per cent of the 38,707 submissions to the Justice select committee were opposed.

But they don’t seem to really believe their own claim because if 90% of the population were, indeed, opposed, you’d imagine they would be very happy for the question to be swamped by a tsunami of hostility at the ballot box and thus settle the matter for a long time

They’d be happy for MPs to pass the End of Life Choice Bill through its next readings, completely secure in the knowledge the public would then dismiss it out of hand.

The quasi-religious Care Alliance was quick to produce press releases asserting the submissions showed almost the entire country was against David Seymour’s bill, but they wouldn’t respond to my repeated question of whether their organisation supported an actual referendum.

The alliance’s secretary, Dr Peter Thirkell, was more forthcoming a year ago when I put that question to him — presumably because at that point a referendum was a more remote possibility. He said then that he believed “an issue as complex and fraught as euthanasia and assisted suicide does not lend itself well to a single-question referendum”.

At the same time, Catholic lobby group Right to Life made its contempt for voters even more obvious in a press release. “The issue of euthanasia is simply too complex to be put to a public vote… Right to Life does not think this is a matter that should be decided by individuals within the community.”

It added: “We also are concerned that should the result of the referendum support euthanasia, this will impose pressure on the conscience of those members of Parliament who are opposed to it, and who want to protect the community.”

In April this year, Renee Joubert, from Euthanasia-Free NZ, replied to my question on Facebook with a similar rationale. “The problem with a referendum is that the euthanasia issue is very complex and nuanced, as demonstrated by the submissions on the bill. There are multiple options for each eligibility criterion and proposed safeguard. There are wider implications and unintended consequences to consider. The issue doesn’t really lend itself to a yes/no question.”

It’s impossible not to conclude that opponents of David Seymour’s bill believe New Zealanders must have become much less intellectually capable since 1992, when a non-binding referendum was held to decide whether First Past the Post should be replaced by a more proportional voting system. Voters had to say, first, whether they wanted to replace FPP and, then, which of four alternative systems should be adopted — Preferential Voting; Mixed Member Proportional; Supplementary Member; or Single Transferable Vote.

An official information campaign conducted before the referendum meant that voters had plenty of information to help make a decision and, unsurprisingly, they handled these complex choices without fuss.

No one could plausibly argue in 2019 that voters haven’t had the chance to thoroughly acquaint themselves with the details and concepts involved in legalising assisted dying. The debate has been raging in public for years, and particularly since 2015 when Lecretia Seales — terminally ill with brain cancer — took a case to the High Court asking that her doctor should not be prosecuted under the Crimes Act in assisting her die with her consent.

If MPs genuinely care about democracy in action, they’ll vote for Seymour’s bill to ensure the nation’s voters have the right to decide for themselves in a referendum.

I guess we’ll find out soon enough who among our representatives believes in direct democracy and who doesn’t.

A time to die? Why I believe in the right to choose. Revd Canon Rosie Harper

Philip Patston — Mon, 13 May 2019 01:50:23 GMT

by Revd Canon Rosie Harper UK | Christians Supporting Choice for Voluntary Euthanasia

“Don’t tell me that the time of someone’s death is purely God’s business. That at the moment when all a human soul wants is for it to end, God stands at the end of the bed and says: ‘No my child, it is my will that you suffer just a few more days.’”………

It’s the beginning of a new year and the script is that we talk about hope. It was a challenging 2017 but things will be OK. New opportunities, fresh blessings, more love and more joy.

So why am I wanting to talk about death? Well, it’s personal and also professional.

It’s personal because I have just booked flights back to Switzerland to go to the funeral of my much loved uncle Albin. He died two days before Christmas, aged 82, gently and peacefully with his family around him. About six years ago his younger brother Otto also died peacefully with his family around him. The difference was that Albin died of old age and dementia, Otto died of a nasty aggressive brain tumour. Albin died ‘naturally’. Otto, being Swiss, was able to request and receive the help he needed to die in a dignified and pain-free peaceful way. This merciful intervention in no way changed the fact of his death, and even now the sorrow is hard to bear, but it did cut short the last bitter agonies of the manner of his dying.

It is professional because in the parish where I work there are a lot of funerals. Mostly the bereaved tell me of the immense kindness of all around; family and friends, doctors and nurses. They tell of the shock of sudden unexpected death and also the oblique conversations about the use of morphine. They also sometimes tell me of bad deaths. Deaths where there is no way of giving the dying person their final wish: ‘Please, dear God, please help me to die.’

Don’t tell me that the time of someone’s death is purely God’s business. That at the moment when all a human soul wants is for it to end, God stands at the end of the bed and says: ‘No my child, it is my will that you suffer just a few more days.’

That is pure fatalism and superstition. Even people who would use language such as ‘God has a plan for your life’ don’t actually mean that everything that happens to them from birth to death is controlled. Of course not. We rejoice in our free will, even in the knowledge that we risk misusing it. That’s part of the deal. Our conception is a risk. We may be born to loving parents, or our mother might have been kidnapped and raped. The will of God? Throughout our lives we make choices and many of them are life and death choices. To smoke or drink or over-eat. To enjoy extreme sports, to ride a motorbike. For all those things we choose and we also take responsibility.

When our lives are nearing the end there are now many societies where that degree of both choice and responsibility remains. That is not the case in the UK.

Just when you might think we need our freedom the most, the medical profession, by law, takes it away from us. Just when you might think that God would most honour the freedom he has given us, the Christian community takes it away from us.

I’m with Hans Küng. If the time comes, and it is necessary for me, I would find it a fulfilment of my life of faith to be able to say to God: ‘Loving Father, I thank you for the most wonderful gift of life. The burden of it is now too much for me to bear and so with every ounce of love and gratitude I can muster I give it back to you.’

Rev Canon Rosie Harper is chaplain to the Bishop of Buckingham and a member of the Church of England’s General Synod.

Cancer snuck up on me. Now I deserve to die peacefully

Philip Patston — Mon, 13 May 2019 01:46:07 GMT

Richard Simpson |14:27, May 09 2019 | Stuff cebook Email

Richard Simpson, pictured at home in his Christchurch garden.

OPINION: As a 47-year-old man, married for 20-something years, two wonderful daughters, running a successful business, the last thing I expected was to be told I had terminal cancer.

It snuck up on me, hiding behind fatigue that I thought was due to working too hard. As a cyclist and runner, I was used to battling fatigue but this was different. More and more often, I found myself on the nod (the advantage of working at home) but stubbornly went about carving away at my business.

It was the cough that took me to the doctors. Four weeks of a cough that went nowhere, did nothing and generally made me grumpy. I went to the doctor, had a blood test, went back for more blood tests and then an ultrasound. There were rumblings in the room that something was not right. One week later and I was in A&E with a painful and swollen leg with the diagnosis of a huge blood clot in my leg and multiple pulmonary embolisms (clots) in my lungs. Then came the good stuff: a tumour on the pancreas, that appears to have spread to my liver and lymph nodes.

Another week later, this is confirmed as cancer with no possibility for surgery. I am now dying and with chemotherapy extending the time I have left, I have perhaps one year, maybe more if I am lucky.

This for an active, live life to the full kind of guy is, as you could imagine, a shock to the core. Over the past few weeks, I have come to terms with my own impending mortality and its arrival faster than expected. My family have taken the news hard but we are managing and coping, planning the time we have ahead of us to be the best it can. We see the year ahead as a time where we get to shape how I want to leave the world.

My family and friends are all that is important to me now and in that respect, I have been very, very lucky. There will be parties, laughter, sharing stories and sharing the rich diversity of the life I have been so lucky to lead. Perhaps that was my problem, I simply burnt the candle at both ends.

Right now, to look at me, I might seem fine, maybe a little thinner than the last time you saw me but otherwise looking OK. My head's been shaved as the family has wanted to do it for years so I finally relented and discovered to my relief that I don't have an oddly-shaped noggin. I’m walking around, smiling and being the same old larrikin I used to be, just a little slower. But I know this will not last.

I’ve finished my first round of chemotherapy but there is no knowing what the remaining 11 rounds will do to me. Once those have finished, will my descent be fast, or will the tumours have retreated? These are all unknowns at this time. The only known right now is to enjoy every precious moment with those I love.

At some point within the discernable future, my body will begin to fail. It will no longer have the energy to fight what is eating it from the inside as I increasingly become a prisoner within the shell I inhabit. There will be no other treatment options other than pain relief as I am forced to lie, sit, slump, whatever it may be and watch my family grow anxious with time. Days will become longer as we wait on tenterhooks before I slip away.

I feel it should be my choice when I decide to leave. My wife and I have discussed this and we agree - prolonging the inevitable is prolonging the pain for all of us. I want to pass with the dignity that reflects the wishes of not just me, but those who love me and those who are close to me. When all the fun has been had, when my body has failed and my mind exhausted, I want to have the option to peacefully die on my own terms.

The notion that I have to remain alive until the doctors can do no more is a harrowing thought. I will have to witness the pain and sadness on the faces of those I care so deeply about.

I believe that when there are no longer any more options to preserve life, pain and suffering are the only knowns, I should be allowed, under New Zealand law to pass with dignity and respect.

Richard Simpson is a Christchurch businessman and father of two.

New poll shows most voters want assisted dying law change

Philip Patston — Wed, 08 May 2019 22:30:02 GMT

Media release Thursday May 9 – for immediate publication

As Parliament prepares to vote on the End of Life Choice Bill this month, a new poll shows a clear majority of New Zealanders want to allow doctors to help the terminally ill to die painlessly and with dignity.

The Horizon Research poll confirmed consistent surveys showing that fewer than one-in-five voters oppose a law change.

The poll, taken last month after the justice select committee reported on a record 39,000 submissions on the bill, found 74 percent of respondents believe that mentally competent New Zealanders aged 18 or over with an end-stage terminal disease like cancer should be able to get medical assistance to end their lives.

Sixty-five percent of voters believe it should also be available for people with “irreversible unbearable suffering which may not cause death in the immediate future” (like motor neurone disease).

In both cases, just 19 percent of New Zealanders were against the proposal.

The pollsters said support for medically assisted dying had risen since Horizon’s first survey on the subject in July 2012, when 63 percent supported a law change.

MPs are expected to vote on the second reading of ACT leader David Seymour’s bill on May 22.

“This shows MPs that a substantial majority of voters remain adamant that they want an enlightened law allowing medical assistance in dying (MAID) despite a vigorous campaign of lies and misinformation mounted by opponents,” Maryan Street, President of the End-of-Life Choice Society, said on Thursday.

There was strong support for MAID across all age groups, ethnicities and political parties, based on voting at the last election in 2017.

All parties currently represented in Parliament had voters who overwhelmingly supported assisted dying ranging in percentages from 65% to 93%.

The poll of 1,341 voters was taken between April 19-29 and the results weighted to represent the New Zealand adult population. Horizon says the margin of error is plus or minus 2.7 percent.

Eds: A graph illustrating key poll results is attached.

More information: Maryan Street, 021-977-555

Released by David Barber, media adviser 021-072-8760

Click to enlarge:

Doctors don’t know

Philip Patston — Wed, 01 May 2019 23:09:35 GMT

Jim Vause | 24 April 2019 | NZ Doctor

It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms

There is something very paternalistic about the “Doctors say no” letter opposing medically assisted euthanasia (i).

The letter’s rationale that, “to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect” is akier than lo.

For a terminally ill patient to ask their doctor to cease their suffering by assisting them to advance their death usually reflects a deep trust often built up over years of a GP-patient relationship. Any GP worth their salt will know this. I do not buy the letter’s argument.

Similarly, the NZMA using the argument that “the proper provision of such (pain) relief, even when it may hasten the death of the patient, is not unethical” to justify opposing doctor-assisted suicide fails when the patient’s desire for death is due to suffering, but not of pain.

Rationality is further eroded by their statement: “We are of the view that permitting individuals to end their lives with the assistance of a doctor — even when that assistance is limited to assessment, verification or prescribing — is contrary to the ethics.”

Standing on the top of a seven-strand fence or dancing on a pin? This seems a common circumstance when it comes to the NZMA arguments, a situation probably resulting from the clinical experience of those realms of medicine opposed to medically assisted euthanasia and one in which palliative care features very strongly.

Causes of suicide

Consider: What is the underlying reason for most persons committing suicide? It is due to mental illness. Depression, anxiety and a few other mental states.

If doctor-assisted suicide was available, how many persons contemplating suicide would seek help rather than killing themselves? Don’t know.

Does palliative care treat these persons? No. Are the mental states leading to suicide treatable or do they attenuate with time? Yo.

In some persons, it is irreversible and they continue to suffer until they die, irrespective of medical intervention. Underlying is a neurological disease, usually degenerative, often difficult to detect, if at all.

It is hard to refute the rationale that ending such a life when suffering is unbearable is better than continued futile medical interventions that don’t work, lead to a loss of dignity (see the NZMA Code of ethics) and cause suffering in their own right.

To end such suffering in a manner that preserves that person’s dignity and is painless, is vastly better and humane than the terror, physically and emotionally, of an ill-planned gruesome suicide with all the concomitant distress and social angst it causes family and friends.

Does allowing the latter through doing nothing meet the NZMA’s Code of Ethics that “requires doctors to always bear in mind the obligation to preserve life wherever possible and justiable, while allowing death to occur with dignity and comfort when it appears inevitable”?

Stench of paternalism

Ultimately, I feel that taking this absolute position, one of medical control, has the malodour of a paternalistic profession that comes from a position of believing that it knows everything about the human condition and can treat all its malfunctioning, when in reality it knows so little about how the brain works, and what it does, and is thus so limited.

Terminal patients want to maintain control, especially for dignity.(ii) We advocate for advanced directives while patient rights are articulated explicitly in our H&DC code, yet we seem to nd it too hard to do the difcult thing, exemplified by the NZMA statement that, “It seems that doctors are somewhat reluctant to take on the weight of the burden that we are asked to assume by legalising active euthanasia.”

It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms. A change in our ethics is only a matter of time.

References

[i] http://doctorssayno.nz/

[ii] J Med Ethics. 2006 Dec; 32(12): 706–710.

doi: 10.1136/jme.2006.015883

PMCID: PMC2563356

PMID: 17145910

What people close to death say about euthanasia and assisted suicide: a qualitative study

A Chapple, S Ziebland, A McPherson, and A Herxheimer

Euthanasia debate: Conflating youth suicide and assisted dying is a bad move

Philip Patston — Wed, 01 May 2019 22:41:23 GMT

by Graham Adams / 01 May, 2019 / Noted

Opinion

Former Prime Minister Sir Bill English and his wife Dr Mary English are fiercely opposed to the End of Life Choice Bill. Photo/Bauer Media/NZ Women's Weekly.

Opponents of David Seymour’s End of Life Choice Bill are pulling out all the stops to kill it on May 22.

If you’re an opponent of assisted dying laws and you want to advance your cause, best not conflate the plight of suicidal young people and that of the terminally ill who are asking to shave a few days or weeks off the end of their lives to avoid the worst of their distress.

It didn’t work well for National MP Simon O’Connor, chairman of the Health select committee inquiry, when he asserted the same false equivalence in 2017 and ran into a storm of criticism. And it’s certainly not working for Dr Mary English right now.

A meme circulating on the internet featuring a photo of the Wellington GP beside the words: “If assisted suicide is a triumph for autonomy and choice, how can youth suicide be a tragedy?” has been howled down.

Libertarian columnist Damien Grant said that while there are good arguments against assisted suicide, that isn’t one of them.

Left-wing blogger Martyn Bradbury, who is staunchly opposed to assisted dying, described it as “ugly”.

Green MP Chloe Swarbrick was similarly outraged, tweeting: “Young people are tragically opting out of their lives because they are not receiving support and they don’t have faith in a better future. They’ve had autonomy and choice stolen from them. Don’t dare equate that to people on their death bed seeking dignity in their final days.”

Others offered false equivalences of their own. As one wag put it: “If a planned heart transplant by a professional surgeon is a triumph of medical science, why is an unplanned heart transplant on a random pedestrian by an untrained amateur with a kitchen knife considered a tragedy?”

You know it’s a howler when even Renee Joubert, from Euthanasia-Free NZ, disowns it. She wrote: “I think it’s important to understand this meme in context. It was not created or published by Dr Mary English but by an Australian anti-euthanasia organisation.

“They took a sentence from her oral submission to Parliament’s Justice Committee, in which she was deliberately using this statement to illustrate a point.”

In fact, if you listen to Dr English’s submission, the words reproduced in the meme represent exactly the point she was making. There was no other context.

And it’s hardly unusual for opponents to make the same odious comparison. On Newstalk ZB in February, her husband, Sir Bill English, told Chris Lynch: “How do we tell young people not to consider suicide as a solution to their depression on the one hand but, on the other, say that if you ask for euthanasia, the state will organise it and provide a doctor?”

You don’t have to be very thoughtful to see the clear difference between a depressed teenager who is going through a rough patch and a rational person who wants help to die to avoid the last, most distressing phase of a terminal illness.

The fact is opponents of assisted dying are pulling out all the stops to derail David Seymour’s End of Life Choice Bill at its second reading on May 22 and the meme featuring Dr English’s statement is just one example of the less-than-admirable tactics they are willing to employ.

On April 27, a group that calls themselves DefendNZ sent a 94-page booklet to every member of Parliament that features a variety of people — from the disabled to doctors — outlining why they don’t want assisted dying legislation passed.

Presumably in an effort to cast its net as wide as possible, the booklet also poses entirely irrelevant questions such as: “Is the End of Life Choice Bill a colonial imposition?”

It states: “The End of Life Choice Bill is largely deaf to Māori conceptions of people and death as well as tikanga Māori” — without acknowledging that the whole point of Seymour’s bill is that it provides only for voluntary assisted dying.

Under the bill’s provisions, Māori — like everyone else — would be entirely free to die in whichever manner they wanted. The bill has no implications for them apart from offering a choice.

On its website, under the heading “The Top 5 Reasons Why MPs Should Vote ‘No’ at the Second Reading”, DefendNZ encourages readers to contact their MP to ask them to vote against the bill.

One of the five reasons suggested to pass on to MPs includes the fact the debate in Parliament will be complex and time-consuming.

DefendNZ warns MPs there will be lengthy debates over amendments to the bill and to “expect the conversations to get longer and much more intense… Should the bill pass its second reading, the Committee of the Whole House stage will likely be extremely lengthy, as dozens of MPs try to fix the bill.”

This amounts to asking MPs: “Why not guarantee yourself an easier life by simply voting it down at the second reading?”

If comparing youth suicide and assisted dying for the terminally ill is an underhand tactic, this appeal to MPs’ self-interest must qualify as a new low in the debate.

We can expect a lot more public campaigning by opponents in the three weeks until MPs get to vote on whether to allow Seymour’s bill to proceed further. The last thing they want is for the bill to be allowed to go to a referendum at the next election because they fear — undoubtedly correctly — that they will lose. If the bill is voted down at its second or third reading, there will be no referendum.

Opponents also don’t want the bill to pass its second reading because it would give Parliament a chance to make it more palatable to those MPs who might approve of the terminally ill receiving an assisted death but baulk at the inclusion of people with “grievous and irremediable conditions”. (Seymour has proposed removing that clause as well as specifying that mental illness and disability alone will not satisfy eligibility criteria, among other changes.)

In other words, opponents don’t want the bill to have the chance of being amended in such a way that it answers many of the objections presented in submissions to the Justice select committee. They are determined to kill it as soon as possible.

The other circumstance that adds urgency to the campaign to sink Seymour’s bill quickly is that on June 19 more than a quarter of Australia’s population will get access to assisted dying when Victoria’s legislation takes effect.

Religious activists in New Zealand and Australia see the two nations as effectively one battlefield. They worry that more victories like Victoria’s will create a domino effect across both nations.

And they have reason to worry. Western Australia’s government is presenting its own bill in August or September, after a year-long, cross-party parliamentary inquiry recommended an assisted dying regime that would look very like the one David Seymour has proposed.

The fact it is a government bill and that support for assisted dying is running at well over 80 per cent in polls in Western Australia means there is a strong likelihood it will pass.

Queensland has a parliamentary inquiry under way that is considering assisted dying legislation for the first time in the state’s history. And another bill will be presented in New South Wales this year, after a Voluntary Assisted Dying Bill failed to pass in the NSW Upper House by just one vote in 2017.

The Australian organisation responsible for the Dr English meme is called Hope, an initiative dedicated to opposing assisted dying, which is allied to the Australian Family Association. The AFA is a Christian lobby group set up by Australia’s most famous Catholic political lobbyist, Bob Santamaria, in 1979.

Some New Zealanders will object to an overseas religious group attempting to influence our laws and will be tempted to respond in the same way as Judith Collins did in March when she learned the NRA was trying to meddle in our gun-law debate. She recommended they “Bugger off!”

Hope, however, appears to be hopeless — at creating effective memes, at least.

This recent extension of its mission across the Tasman certainly looks to have been more hindrance than help to those who are keen to kill Seymour’s bill.

New Jersey Governor Philip Murphy signs Medical Aid in Dying for the Terminally Ill Act

Philip Patston — Mon, 29 Apr 2019 22:01:09 GMT

New Jersey Governor Philip Murphy / Patch

GOVERNOR’S STATEMENT UPON SIGNING

ASSEMBLY BILL NO. 1504

(Second Reprint)

Today I am signing the “Medical Aid in Dying for the Terminally Ill Act”, Assembly Bill No. 1504 (Second Reprint), which permits terminally ill, adult patients residing in New Jersey to obtain and self-administer medication to end their lives peacefully and humanely. I commend the bill’s sponsors — particularly Assemblyman Burzichelli, for whom this bill has been an extremely passionate and personal mission since he first introduced it seven years ago — for their tireless efforts to craft legislation that respects the dignity and autonomy of capable individuals to make end-of-life decisions.

The legislation I am signing today is the product of a near-decade long debate among policy makers, religious organizations, experts in the medical community, advocates for persons with disabilities, and patients, among many others. Without question, reasonable and well-meaning individuals can, and very often do, hold different moral views on this topic. Through years of legislative hearings, countless witnesses, many of whom shared deeply personal and heart-wrenching testimony, offered compelling arguments both in favor of and against this legislation.

As a lifelong, practicing Catholic, I acknowledge that I have personally grappled with my position on this issue. My faith has informed and enhanced many of my most deeply held progressive values. Indeed, it has influenced my perspectives on issues involving social justice, social welfare, and even those topics traditionally regarded as strictly economic, such as the minimum wage. On this issue, I am torn between certain principles of my faith and my compassion for those who suffer unnecessary, and often intolerable, pain at the end of their lives.

It is undeniable that there are people with terminal illnesses whose lives are reduced to agony and pain. Some of these individuals may thoughtfully and rationally wish to bring an end to their own suffering but cannot do so because the law prevents it and compels them to suffer, unnecessarily and against their will. I have seen such debilitating suffering firsthand in my own family, and I deeply empathize with all individuals and their families who have struggled with end-of-life medical decisions. As things now stand, it is the law, rather than one’s own moral and personal beliefs, that governs such decisions. That is not as it should be. After careful consideration, internal reflection, and prayer, I have concluded that, while my faith may lead me to a particular decision for myself, as a public official I cannot deny this alternative to those who may reach a different conclusion. I believe this choice is a

personal one and, therefore, signing this legislation is the decision that best respects the freedom and humanity of all New Jersey residents.

Date: April 12, 2019

/s/ Philip D. Murphy

Governor

Choice on dying currently extends only one way. How cruel is that?

Philip Patston — Tue, 16 Apr 2019 23:09:14 GMT

by Andrew Geddis

Source: The Dominion Post

ROSS GIBLIN/STUFF

David Seymour, sponsor of the End of Life Choice Bill, is looking to will propose changes at a future stage of the debate that will limit the any legislation's scope.

OPINION: Alex Penk, chief executive of the Maxim Institute, has concerns about the End of Life Choice Bill currently awaiting a second reading in Parliament. There's nothing wrong with that, as the issue is one that reasonable people can disagree on.

However, I think some of his concerns are misplaced, and others are missing some important context.

First of all, Penk worries about the parliamentary process being used to pass this proposed law. Its sponsor, David Seymour, will propose changes at a future stage of the debate that will limit its scope. That fact means that the bill's final shape is still somewhat uncertain.

However, what he doesn't note is that this process is required because those MPs on the justice select committee opposed to the bill blocked Seymour's changes from being incorporated into it at that earlier stage. No doubt they worried that other MPs would be more likely to support this limited bill than the original version.

It's then a little rich for the bill's opponents to complain that it is being enacted via a flawed process. And in any case, it seems almost certain that any final bill will require a referendum vote to become law, giving the ultimate say on its merits to the voters themselves.

Penk then raises the spectre that any legislation may be misapplied, leading to "deaths that would fall outside the bill's own criteria". This could occur, he worries, because of the difficulties involved in determining whether someone at the end of life really is competent to consent to a doctor's actions.

Of course, the End of Life Choice Bill requires that anyone requesting aid in dying be fully and directly informed of that decision's consequences. Their doctor also must use best efforts to ensure the request is free from pressure from any other person.

Two doctors would then independently assess the competency of that person to request aid in dying. If either doctor disagrees about this, a third specialist would be brought in to examine the case.

Compare this process to a lucid person with late-stage cancer who says that they want to end treatment and "let nature take its course". Although that decision will result in the patient's death, their doctor simply has to accept it as a competently made choice without any prescribed process being followed.

As such, we see shifting concerns about "competence", depending on what people are choosing to do. My suspicion is that these concerns don't really reflect an underlying judgment about whether people at their end of life are able to properly consent to treatment; after all, they already do so on multiple occasions every day.

Rather, it comes from a fear that people will choose something those opposed to aid in dying just don't like.

Penk then points to the slippery slope that opponents of aid in dying reliably claim will follow any legislation. In his case, it is to warn that other countries have extended access to people under 18 (which the End of Life Choice Bill would not allow).

It's an interesting argument that we can't possibly change the law today because we cannot trust some future majority of MPs, elected by a future majority of voters, not to change it further.

Laws in New Zealand do not alter by magic; they require Parliament to decide to act.

So, if and when there was some future proposal to widen the range of people who may access aid in dying, that would involve a new bill and full public debate on its merits. If we then collectively think the further change is a good idea, we can do it. If not, then we don't have to.

So, rather than worry about what our future selves may decide to do at some point years from now, we should ask ourselves whether the proposal in front of us today is a good one.

For as Penk notes, allowing aid in dying will mean people approaching the inevitable end of their lives can ask themselves: is my life still worth living? For some people, with their death approaching and experiencing unbearable suffering, the quite understandable answer will be no.

Are we as a society then going to be so cruel as to tell them, in effect, "tough luck"?

* Andrew Geddis a professor of law at Otago University.

Progress on euthanasia Bill is 'big win' for David Seymour - Tova O'Brien

Philip Patston — Fri, 12 Apr 2019 01:31:55 GMT

Source: Newshub

Getting his euthanasia Bill to its second reading in Parliament is a big win for David Seymour, according to Newshub's Political Editor Tova O'Brien.

On Tuesday, the Justice Select Committee reported back on the ACT leader's End of Life Choice Bill, which would give people the option to request assisted dying if they have a terminal illness or a "grievous and irremediable medical condition".

As not all committee members agreed it should be passed, all MPs will have a chance to "resolve the broader policy matters" in the House, the committee's report said.

O'Brien said that select committee process had been unprecedented.

"That select committee process was incredibly fraught, it was unprecedented, it went for 16 months, nearly 40,000 submissions," she told The AM Show.

Regardless of if the Bill passes its second reading when it heads back to the House in roughly six weeks, O'Brien said Seymour had accomplished a lot.

"This is huge and I think any MP that gets a Bill plucked out of the member's ballot, it's a lottery in the first place... it is pure serendipitous luck if it comes out," she said.

"To get it plucked out from the ballot and then to not have it shot down immediately is huge.

"Something like euthanasia, which is a major issue in New Zealand and all around the world, this is a conscience vote and to have it kinda progress in the way that it has, this is a big win for David Seymour."

There is still division in Parliament over the Bill, with many MPs, including National's Simeon Brown and Maggie Barry, staunchly against it.

Others outside of Parliament are also opposing it, including the New Zealand Disability Rights Commissioner, the New Zealand Medical Association and Hospice New Zealand.

Former Prime Minister Bill English has come out strong against the Bill, warning that making euthanasia legal in New Zealand would be a "slippery slope" and there weren't enough safeguards in the Bill.

But Prime Minister Jacinda Ardern has signalled her support, something O'Brien said was unusual.

"Often she doesn't really signal which way she is going to go with these things, but she has in this case. I suppose it was going to be public pretty soon, but it can influence people in her party and it can also influence the public."

Public opinion also seems to be on Ardern and Seymour's side, with a Newshub-Reid Research poll last year finding 71 percent of people supported the Bill, with 19.5 percent opposed and 9.5 percent unsure.

But the public will have a more official method of expressing their support if Winston Peters has his way.

"If it does pass, and make its way into law, then it goes out to you, the public, because Winston Peters is only pledging his support for this Bill if there is a referendum," said O'Brien.

"So if it does all pass, and go through in that way, that will be tacked onto the 2020 election."

Newshub.

End-of-Life Choice Society disappointed by Parliament’s Justice Select Committee’s report

Philip Patston — Tue, 09 Apr 2019 04:17:15 GMT

Media release from the End-of-Life Choice Society of NZ Inc. 9 April 2019

The End-of-Life Choice Society said Tuesday it was disappointed Parliament’s Justice Select Committee’s report into assisted dying was not bolder given the overwhelming support for a law change New Zealanders have consistently shown in reputable opinion polls.

But the society’s president Maryan Street said that it was legitimate to pass the issue to the full Parliament as it will be decided on a conscience vote by MPs. She said the committee was never likely to agree on any significant recommendations on the bill.

“It is encouraging that the committee has left the policy content of the bill largely intact, with only minor, technical and consequential amendments.”

She said not all MPs will have had a chance to hear all the expert submissions on how similar laws with stringent safeguards work overseas where nearly 200 million people in Europe, North and South America – soon to be joined by the Australian state of Victoria – have enlightened assisted dying legislation.

Maryan Street said these laws work without the worst fears of scaremongers being realised. She urged MPs to reflect the majority opinion of New Zealanders, and not be influenced by deliberately misleading information designed to advance a minority agenda.

Maryan Street, President, End-of-Life Choice Society NZ

maryan.streetnz@gmail.com

NOTE: Maryan is overseas until Monday 15 April but available by email and phone

Tel: 64-21 977 555

Released by David Barber, EOLC media adviser 021 072 8760

Tensions and hot tempers over euthanasia law

Philip Patston — Mon, 08 Apr 2019 23:44:54 GMT

Source: Newsroom

Over the past 16 months tensions have risen and tempers have flared as a parliamentary committee considers the controversial assisted dying bill. Laura Walters takes a look behind closed doors at the journey of the End of Life Choice Bill.

The end is in sight for David Seymour’s euthanasia bill, after more than a year of public meetings, thousands of oral submissions, and some select committee scraps.

Newsroom understands that during the process, tensions between politicians rose to the point where some members of Parliament's Justice Committee were concerned no report would be produced.

But co-operation within the select committee room has been somewhat restored over the past couple of months, and on Tuesday afternoon the committee will report back to the House with what’s expected to be a revision-tracked report.

Seymour may have hoped the committee process would take the bill slightly further, with the three main changes needed to get the support needed to pass the bill through its second and third reading and onto a public referendum in 2020.

But no matter: if he has to, he will no doubt draft the necessary amendments – with the help of lawyers – and put them to the House during committee stages later this year.

All things being equal, the bill is expected to pass by the end of this year.

Seymour will be hoping that gives Justice Minister Andrew Little and the Electoral Commission enough time to get the question on the ticket in time for the 2020 election.

ACT leader David Seymour entered his own private member’s bill into the ballot in October 2015. Photo: Lynn Grieveson

Long ride to justice committee

While it might seem like things are on track now, this is a recent development in what’s been a long and hard-fought battle for the bill.

The proposed law is controversial and lends itself to emotive responses. An added complication is the fact MPs will vote based on their conscience rather than along party lines.

There has also been a coordinated and hardworking opposition campaign, with two leading campaigners sitting on the committee considering the bill in the form of National’s Nick Smith and Maggie Barry.

It all began when former MP Maryan Street presented a petition, asking Parliament to investigate public attitudes to law that would allow medically-assisted dying for people with terminal illnesses or irreversible conditions which were making their life unbearable.

The petition came soon after the court case of Wellington lawyer Lecretia Seales who, diagnosed with a terminal brain tumour, challenged New Zealand's euthanasia laws in the High Court asking for the right to die with the assistance of her GP.

The health committee carried out the inquiry, but then-Prime Minister John Key ruled out the government introducing its own voluntary euthanasia bill.

Seymour’s frustration at the campaign run by the Catholic Church grew.

Meanwhile, ACT’s Seymour entered his own private member’s bill into the ballot in October 2015, and in June 2017 it was introduced to the House.

In December 2017 it passed its first reading in a conscience vote of 76 to 44, with Seymour asking that it be reported back to the House nine months later.

Record number of submissions

It fast became clear this was a hot topic, and the Justice Committee received more than 35,000 written submissions. Seymour has repeatedly likened the debate to other contentious issues like prostitution law reform, and marriage equality.

Many of the submissions were short – sometimes as little as one sentence – and in line with other submissions from groups opposed to the bill. Seymour’s frustration at the campaign run by the Catholic Church grew.

Well-known Catholics, and the country’s former first couple, Mary and Bill English, were happy to put in the hard yards for the ‘against’ campaign.

Former Prime Minister Bill English and his wife Mary, committed Catholics, have been active in opposing proposed changes to euthanasia laws. Photo: Lynn Grieveson

Mary English, who is a GP, has spoken at the select committee and at town hall meetings across the country. Her husband, who holds the same view, has also opposed the bill, but it's clear Mary is the more fervent of the two.

National’s Maggie Barry, who was also raised Catholic, has stepped in where the the couple have not been present. Barry has fronted at debates against Seymour, and spoken against the bill at public meetings.

It’s understood she was also the mastermind behind the plan to push for every Kiwis’ right to have their submission heard orally by the committee, if they desired.

This led to an impressive form of filibustering and kept the committee busy for five months.

During the consultation process, about 3500 people asked to speak directly to the committee, but not all who expressed an interest showed up to say their bit. A rough calculation puts oral submissions between 1500 and 2000, spread across 40 hearings. The average length of a submission was nine minutes, and hearings ran an average of six hours.

A complaint was made that Maggie Barry was "demeaning" to submitters during the hearings. Photo: Lynn Grieveson

It is important to hear a range of oral submissions when select committees are considering legislation, as it gives people a chance to speak to their written submission, and for the committee to ask specific questions, or draw on the person’s expertise and experience. But many of the oral submitters expressed the same point of view, and did not suggest ways to change the substance of the bill, rather to state they were morally and spiritually opposed.

Questions were also raised about Barry's demeanour and treatment of submitters during the hearings. Last year, euthanasia advocate Dr Jack Havill lodged a complaint against Barry, saying she was showing bias and was “disparaging to submitters”.

In the end, both written and oral submissions were overwhelmingly opposed to the proposed law.

Analysis by anti-euthanasia group Euthanasia Free, found about 85 percent of published oral submissions were opposed. About 13 percent were in support and 3 percent were either unclear or neutral.

Meanwhile, the Care Alliance analysed almost all of the submissions made on the bill and found 90.2 percent were opposed, 8.1 percent were in favour and 1.7 percent were neutral or unclear. The alliance is also made up of conservative groups opposed to the bill.

However, Otago University research from last year found on average, 68.3 percent of all New Zealanders supported euthanasia with 14.9 percent opposed. The rest were neutral or unsure.

The survey analysed existing research investigating New Zealanders’ attitudes to euthanasia or assisted dying over the past 20 years. It included views of 36,304 Kiwis.

The home stretch

Once the countrywide roadshow wrapped up in November, the select committee came back to Wellington to work on its report to the House, including any changes and recommendations.

This was easier said than done, with a split committee of four Labour MPs and four National MPs, including Maggie Barry and Nick Smith.

The committee’s four Labour MPs voted for the bill in its first reading, and National’s Chris Bishop and Mark Mitchell also voted in favour.

But Newsroom understands National has stuck together inside the committee room, with Smith and Barry continuing to lead the charge against the bill. As recently as February, one member said there was a risk of the committee not producing a report.

By March it looked like National would only support some small technical changes, rather than any substantive amendments, which would be ultimately be needed to get the support of the Green Party and New Zealand First.

But recently, the eight, plus Seymour who has been joining the group as a non-voting member, have improved relations to produce what’s expected to be a revision-tracked report, accompanied by substantial commentary.

That commentary will likely address the amendments necessary to get it through the next two votes.

To be on the safe side, Seymour has produced his own sponsor’s report, which he says outlines recommendations on how the bill might be improved.

This would usually be the job of the select committee, but given the mood of the room, Seymour obviously wanted to be sure he was being as clear as possible about what he thought could be changed, while maintaining the essence and intent of his bill.

It’s understood to also be about half the length of what will be released by the select committee on Tuesday afternoon.

In his report, Seymour suggests including a binding referendum on the commencement of the bill at the 2020 election (in order to lock in New Zealand First’s nine votes). He also suggests amending the eligibility criteria to limit eligibility to terminal illness and, for avoidance of doubt, stating that access to assisted dying cannot be by reason of mental health conditions or disabilities only (to ensure eight votes from the Green Party caucus). He suggests incorporating the Access to Palliative Care Bill sponsored by Barry (in the hope of securing the nine votes needed from National to move it through second and third reading). These changes would be added to the bill at committee stage.

Seymour has told media he is happy with how things have ended, and “quietly confident”.

Now it’s onto the home stretch, with the bill most likely to come up for second reading after Budget speeches conclude in July, and pass by the end of the year, in what's expected to be a chaotic scene in the House, with MPs walking through the doors to vote for each change, as well as to show their final position.

Then the politicians' work is done, and all will be in the hands of voters come polling day, 2020.

Inquiry hears Queenslanders’ strongly-held views on euthanasia laws

Philip Patston — Sun, 07 Apr 2019 21:51:27 GMT

Source: Aged Care Insite

Traumatised families and nurses have swamped an inquiry with accounts of harrowing deaths in a bid to convince Queensland to introduce voluntary assisted dying laws.

More than 170 submissions have so far been lodged as the state government attempts to gauge the level of public support for euthanasia.

Early results indicate a groundswell of support for change, with about 140 of the submissions urging a shift to medically-assisted dying with the right safeguards in place.

Just 40 submissions have argued against any reforms, variously describing right-to-die laws as dangerous, state-sanctioned murder and a grave violation of God’s law.

One of the most powerful submissions for change was written by Carol Cronk, who is planning to go to Switzerland to end her life and avoid the kind of deaths her parents experienced in high-dependency dementia wards.

She describes her 93-year-old mother’s death, after she suffered “unfixable” broken shoulders and ribs during a nursing home fall before she was sent to her final “death ward”.

“[She] was forced to live in this death ward in 24hr pain and intense shame, toilet issues, all in her nappy, fed like a baby and machine hoisted, naked, by strangers into a shower. Her everyday screams were for God to take her,” Cronk wrote.

“Personal experiences change our beliefs systems. I have a terminal illness, and have already contacted Dignitas Switzerland re my need to be forced into going over there, to be spared.”

Another supporter, Linda Roberts, has told the government inquiry that she almost gave in when her ailing mother begged for help to die.

Living with cancer and in terrible pain, her mum pleaded for extra doses of heavy-duty pain medication, after telling her family she’d “had enough” and urging them: ‘Please help me’.

“I was shocked that she asked this of me and it took me a period to digest what she asked me to do,” Roberts wrote.

She reached the point where she was seriously considering doing what her mother had asked.

“The only thing that prevented me from granting my mother’s wish was that I had to consider my own two children and the consequences of my actions had I gone through with this.”

One week later, her mother’s pain was no longer manageable at home, and she was put into a palliative care facility. There, Roberts said, doctors approved massive doses to her pain medication and hastened her death.

Former police officer Laurie Paul told the inquiry of attending countless suicides in his long career, but one in Townsville has stayed with him.

“We were directed to the back yard shed. There lay an elderly gentleman who had suicided – his elderly wife and family grieved for him upstairs,” he wrote.

“He had recently been advised that he had cancer and in his loving note to his wife of many years, outlined that he was of the view that he did not wish for her to suffer as he slowly died in front of her, and that she would have to nurse him in the last years of their lives.

“This was wrong and a sad indictment on our society.”

The government inquiry is broader than assisted dying. It’s also delving into the adequacy of aged care, and end-of-life and palliative care.

A large number of submissions supporting assisted dying have been lodged by nurses who work in palliative care, and say the idea that drugs can always manage pain and deal with suffering is nonsense.

“Sometimes there is never a high enough dose of medication to ease the pain,” retired nurse Jill Glover wrote.

Verena Sidler said she’d witnessed countless horrible deaths in her 30 years as a registered nurse.

“I can recall numerous patients with terminal illnesses who spent their valuable energy literally begging myself and other nurses ‘to be put out of their misery, indignation and pain’… until dying.”

When her own father was diagnosed with pancreatic cancer, she was grateful he lived in Switzerland and used that country’s laws to end his life peacefully in his own home.

“Two weeks prior to my father’s death, I asked him what had helped him most to improve his quality of life since being diagnosed with this terminal illness and he answered, the knowledge that he did not have to die a terrible death without having any control.

“I entreat you to consider voluntary assisted dying.”

Of the 40 submissions arguing against change, many said better palliative care options would negate the need for assisted dying laws.

“What the terminally ill who are in pain want and need is proper care and pain relief, not an end to life. Theirs is a cry for help that better and proper palliative care can certainly deliver on,” Karen Mitchell wrote.

Anne Coyle warned voluntary euthanasia would lead to murder.

“It is impossible to control euthanasia once it has been legalised. All countries who have legal euthanasia have records of patients being euthanised against their will,” she said, without citing any specific examples.

Other opponents said God gave life and only he could take it away, a view shared by Donald and Glenice Larsen, who both lost their previous spouses to cancer.

“[They] were afforded the best possible palliative/end-of-life care, in as much as pain control and being made comfortable… As Christians we believe what God has told us in His Word – He is the giver of Life and we have no authority to take it away.”

Public submissions to the inquiry close on April 15.

Media release: MP is lying over assisted dying bill

Philip Patston — Tue, 02 Apr 2019 07:05:51 GMT

Media release From the End-of-Life Choice Society 2 April 2019

MP Maggie Barry has resorted to lying in her campaign to prevent a law change that would allow terminally ill patients to die peacefully in dignity with medical assistance, the End-of-Life Choice Society said on Tuesday.

Barry, who is on Parliament’s Justice Select Committee considering the change, told TVNZ’s Q&A programme Monday night that people in Canada with “dementia, anorexia and arthritis” were being euthanased. She also claimed that children were being euthanased without their parents’ knowledge or consent.

None of that is true, EOLC vice-president Mary Panko, of Auckland, said Tuesday. To qualify for medical assistance in dying (MAID) under Canada’s law, people must be 18 years of age or older and have a grievous and irremediable condition.

They must have made a voluntary request, not under any external pressure, be evaluated by two independent doctors and give informed consent to MAID after being informed of means to relieve their suffering, including palliative care.

They must have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline, endure physical and psychological suffering that is intolerable and their natural death has become reasonably foreseeable. They must be mentally competent of providing informed consent at the time they receive MAID.

Ms Panko said: “It does not serve democracy when an MP deliberately seeks to foil a law change that 70% of voters want - despite a vigorous misinformation campaign based on blind dogma - with tactics designed to frighten the uninformed.

“She slurred the medical profession by asserting that some doctors would ignore the extensive safeguards in David Seymour’s Bill, accused the disabled of not being able to make their own decisions and claimed that a large segment of the population would want their parents or grandparents dead.

“Her tactics, seeking to stop New Zealanders getting an enlightened law of choice that nearly 200 million around the globe now have, are dishonest and dishonourable for someone who claims the title Honourable.”

Mary Panko – marypanko2@gmail.com Tel: 027-419-7802

Released by David Barber, EOLC media adviser 021-072-8760

On the same subject, David Barber also sent this in response to a letter in the DomPost

How interesting that Michael Vanderpump (Letters, April 8) should mention "common sense and the truth" when opposing the End of Life Choice Bill.

These qualities have been singularly missing in the dogma-based opposition to the measure. It is common sense that people should not have to suffer in their dying days - and there is ample evidence that currently some do.

And the Honourable Maggie Barry has repeatedly dishonourably and dishonestly told lies in her rabid opposition to a law change that a clear majority of New Zealand voters want.

Lecretia Seales' widower makes his case for death with dignity

Philip Patston — Fri, 22 Mar 2019 20:59:10 GMT

by Matt Vickers

After being diagnosed with a brain tumour, lawyer Lecretia Seales took a case to the High Court challenging for her right to die with the assistance of her GP. Photo/Listener/Hagen Hopkins.

As Parliament’s Justice Select Committee prepares to report back on David Seymour’s controversial End of Life Choice Bill, Matt Vickers – the widower of assisted dying advocate Lecretia Seales – makes his case for death with dignity.

Most of us take few one-way journeys in our lives. No matter how far we venture from home, whether for a day, a week, a month or for years, we usually return. Leaving home for good is generally paired with a major life event: university, a new job, marriage. A new start in a new place.

But not every one-way journey is about starting a new life. Every year, around 200 people make a journey to end one. They travel from their homes in Britain, Australia and New Zealand, to go to Zurich, Switzerland to die.

An appointment in Zurich does not have the same connotations as the fabled meeting with “Death” in Samarra. It’s a beautiful, scrupulously clean city stocked with watchmakers, wine bars and chocolatiers. In September, its narrow cobbled streets smell faintly of candy-floss. Bankers and tourists sit outdoors at the restaurants and bars lining the Limmat River, their minds more inclined toward skiing than mortality.

It’s here that Dignitas does its work, giving people suffering from dreadful illnesses or terminal prognoses a way to cut their lives short. Switzerland is not the only country in the world to offer assisted dying, but if you want assisted dying and you don’t live in a country that offers it, Switzerland is the only country in the world willing to help a foreign citizen like you.

Silvan Luley, a tall, grey-haired Swiss board member of Dignitas, is not happy about that. “It’s an atrocity that someone from Australia, New Zealand, the UK or anywhere on this planet has to travel to Switzerland if the only thing that he or she wants is to have a peaceful end to their suffering in life. How can a state treat people, who pay taxes all their lives, this way; to say, ‘If you want to end your life self-determinedly, I don’t care, go to Switzerland.’

“We shouldn’t be here. Dignitas shouldn’t exist. And this is actually our goal: to disappear. This is what we have been working for, for 18 years. Because when other countries allow sensible choices for their people, then they don’t need to travel here. And if we have implemented that around the world, then we can close down.”

New Zealand’s latest debate on assisted dying was partly initiated by my late wife, Lecretia Seales, who sought to have the right to be assisted to die if she chose to. She wanted to be able to access services such as those offered by Dignitas, but not to have to leave her country to get them. Like almost everyone, she wanted to be close to her home and her family when she died. But she also wanted control over how and when it happened.

My wife died in 2015 without winning that choice, but New Zealanders may end up with more options about how they die very soon. The End of Life Choice Bill, a members’ bill sponsored by Act MP David Seymour, which aims to offer assisted dying, is due to come back to parliament for a second reading sometime in the next few months.

Luley has no doubts about the importance of having assisted dying as an option. “It’s not about doing it or not doing it. It’s a choice. There’s an emergency exit door if the worst comes to the worst. I don’t need to go through that door, but it’s good that it’s there.”

The Dignitas office is about 30 minutes from the centre of Zurich by train, in a nondescript building with no signs on the door. Inside is a quietly efficient workplace with around 10 staff. In one room, there are four floor-to-ceiling file carousels, each filled with coloured folders. Each colour means something different: a blue folder means a case is under assessment; red, a person is no longer a member of Dignitas; yellow, a case has been approved but the individual has not yet chosen to come to Zurich (and may never come; approval provides the option to travel to Zurich, but not the obligation); and green, an individual completed the vetting process and was assisted to die at his or her home, or at one of the homes provided by Dignitas.

Swiss citizens strongly support the existence of Dignitas and organisations like it: in 2011, two religiously motivated political parties initiated two referendums, one to prohibit assisted dying and the other to end what they called “suicide tourism”. But 85% of Zurich citizens voted to keep assisted dying legal, and 78% voted to continue to allow foreign nationals to access it.

I ask Luley what the people who come to Switzerland are like. “Very autonomous, self-determined people,” he says. “In fact, that’s what most people write in their requests. ‘Look, I’m now 80, I’ve survived the war, I survived the Depression times after the war, I’ve worked all my life and I’ve done what a man needs to do and I’ve brought up my family and so on. It’s my life, it’s my choice... I’m going to [keep deciding] until the very last moment, and it’s my decision to end my suffering when I want.’”

This is consistent with findings in Oregon, the first US state to legalise assisted dying, in 1997. Studies have shown applicants tend to be disproportionately well-educated, wealthy and white: the very opposite of what society and critics would consider vulnerable.

Does Luley worry about coercion, or that a person’s motivations may be inauthentic? “I’ve never seen that. Maybe it has to do with the procedure and how the system works, especially with people coming from abroad. They go through at least a three- to four-month preparation procedure, and repeatedly have to show they want to go this way and that no one is pushing them. Apply for membership, fill out the advanced directive, write the formal request, write the life report, the CV, gather the medical reports, proof of identity and documentation and send it all to us. It’s a lot of paperwork they have to do, and they have to take the initiative themselves again and again.

“People who have thought about their situation and consider the options and then decide rationally to end their life… it takes a lot of courage. I don’t know whether I would be able to do that. I think we humans are just like animals, we cling on to life because that’s all we have in this world. Our brain stem tells us to live and to prosper and to have kids and to live on and longer. Deciding against that very basic driving force within us, and to say ‘No, with my intellect, I decide to overrule that, and end everything’ – that’s very brave.”

The Swiss assisted-dying clinic Dignitas, in Pfaeffikon, near Zurich. In Switzerland, providing the means for a person to take their own life is legal if done from non-selfish motives.

In New Zealand, the Swiss example – where doctors may only “assist” by providing the means to die – is rarely mentioned. Opponents focus on what they perceive as the broad remit of the Dutch and Belgian regimes, or the unsupervised example of the Oregonian model.

“In Switzerland, the assisted dying system has been working almost perfectly fine for 35 years, supported by physicians and with the assistance of non-profits like Dignitas,” says Luley. “We are not a good example for opponents, because... they would have to admit the most progressive-liberal system works fine, without abuse, without people being pushed to commit suicide. Without so-called vulnerable groups being under threat, without the value of life being eroded.”

In Oregon, a patient must be terminally ill with a prognosis of less than six months to live, but once that criterion is met and the doctors satisfied through a series of consultations that the patient is acting rationally, they are prescribed a medication they take home with them, and that they are free to take any time. However, they must take it without assistance.

In the Netherlands, a patient must have grievous suffering and be able to satisfy doctors they genuinely wish to be assisted to die. However, the drug is administered by a doctor under medical supervision; they are not permitted to take the drug themselves. In Belgium, doctors can help patients to end their lives when they freely express a wish to die because they are suffering intractable and unbearable pain.

Seymour’s bill, with the support of parliament, may settle on criteria similar to Oregon’s, but with a more Dutch- or Swiss-style system of supervision. This greatly restricts the ability for people to get assistance to die, but it also ensures that complications with taking the life-ending drug – a criticism of the unsupervised Oregonian system – are minimised, as a professional is on hand to ensure it is administered correctly.

For me, a terminal illness is what clearly distinguishes an assisted death from suicide. When death is imminent and inevitable and there is no choice to live, dying without suffering is inarguably humane. In New Zealand, where suicide statistics are a national tragedy, being able to make a clear distinction between assisted dying and suicide is important.

Opponents argue that six months is very subjective, and a patient could live for many months more. And that’s true. But six months simply gate-keeps the long, administrative process of winning access to assistance – it is not the timeframe in which the drug must be taken. The data suggests patients who do end their lives early do so by an average of fewer than 10 days.

But Dignitas does not think a six-month prognosis is a good place to draw a line. In this, it agrees with groups such as New Zealand’s End of Life Choice Society (until recently the Voluntary Euthanasia Society), run by former Labour MP Maryan Street. “Discrimination is not the way to go, and a six-month terminally ill model is definitely discrimination against people with long-term ailments who suffer badly but are not expected to die in a few months,” says Luley.

However, he acknowledges the line has to be drawn somewhere. “There is probably always a certain category of people who really suffer, but how do you want to make it objective? One thing is for sure: people wish for real freedom of choice in end-of-life issues. A restrictive law, such as in Oregon, does not live up to what all supporters want. It leaves many suffering people in despair, having to take to drastic measures, such as a lonely, risky suicide attempt, with dire effects on themselves, their loved ones and society in general. Or they travel to Dignitas, if they still can.”

Luley and I emphatically agree on one point: “Giving access to assisted dying is, in fact, suicide prevention and suicide-attempt prevention.” In Seales v Attorney General, this was upheld by Justice David Collins, based on 100 years of evidence from New Zealand’s coronial records. About 5-8% of all suicides here are people attempting to escape the worst of their medical conditions, killing themselves in awful, lonely and often violent ways.

These people might live longer if they could talk freely to their doctor about assisted dying, whether they go through with it or not. Under the current law, a huge part of the problem is people not talking to medical professionals about a wish to end their life early.

The writer, Matt Vickers, holds a photograph of his late wife Lecretia Seales while making a submission to the Justice select committee considering the End of Life Choice Bill in August 2018. Photo/Mark Mitchell/NewspixNZ.

Dr Juan Mendoza-Vega was the president of Fundación Pro Derecho a Morir Dignamente (DMD), a Colombian right-to-die organisation, and until 2015 the only substantial organisation of its type in Latin America. Sadly, Mendoza-Vega died in 2017 of natural causes, but I had the opportunity to meet him in Bogotá before he passed. There, he worked with his team to facilitate assisted dying for Colombians, supported by a constitutional ruling won two decades earlier.

Colombia is an anomaly in the short but growing list of countries that allow assisted dying. Generally such countries are Western, democratic and secular. Colombia is a Catholic-majority country (73% of its citizens are Catholic), surrounded by five other Catholic-majority countries. Its population is primarily made up of the soccer-playing sons and daughters of Spaniards, indigenous Americans, and Africans. In fact, the legality of assisted dying in Colombia is due only to a legal own goal.

Under the Colombian penal code (the equivalent of our Crimes Act), murder and assisted suicide are illegal. Unlike our Crimes Act, the code explicitly spells out that a murder or assisted suicide with a motivation of pity, to end intense suffering from bodily injury or disease, is also a serious crime. However, this category of crime – a crime of compassion – has a slightly lesser sentence.

A crusading young Bogotá lawyer, José Eurípides Parra Parra, believed that having lesser penalties for murder and assisted suicide based on motivation violated the right to equality in the Colombian constitution. He believed that no matter the motive of the criminal, a victim of murder or assisted suicide deserves equal justice, and thus an equal sentence for the offender.

However, his case had the opposite outcome to the one he intended. The Colombian Constitutional Court instead ruled that if a terminally ill patient had given authority to have their life ended, then a physician helping them could not be held criminally responsible. Not only did this contradict the penal code: as superior law, it overruled it. With one decision, the court legalised assisted dying for the entire country. Assisting a suicide was still illegal, but voluntary euthanasia performed by a physician on a willing patient was no longer a crime.

In 2014, Ovidio Gonzalez, a 79-year-old Colombian man suffering from throat cancer, sought to be assisted to die, but couldn’t find a physician who would help him. Most doctors believed it was still illegal despite the constitutional ruling. Gonzalez petitioned the court, and the court not only reaffirmed the patient’s right but instructed the Colombian Ministry of Health to provide norms and practices for assisted dying. Since then, assisted dying has been unambiguously legal.

Have the floodgates opened since then? Mendoza-Vega told me they hadn’t. In the most recent year he monitored, there were no more than six assisted deaths recorded in the whole country. “It’s not very frequent,” he said.

But for him, the number wasn’t important. He echoed Luley on the importance of choice. “Dignity in dying is really respecting the person who is dying until their last moment; respecting his or her will and decisions... If that person decides to suffer, that’s dying with dignity also. If this person says, ‘I want palliative care,’ that’s dignity in dying. We respect a person choosing euthanasia, and we respect all other forms of dying that he or she decides.”

Unlike the Dutch and Belgian models, the Colombian model has not had a great deal of public scrutiny in Western media. A patient who wishes to be assisted to die will contact DMD, which will aid the person, but with the same checks found in Western countries, including a review by two doctors and a psychological assessment. The person has to have a terminal diagnosis, with no corrective treatment available.

By working quietly, DMD aims to avoid scandal and protect the privacy of the family of the deceased. Colombia is prone to having the public details of any cases excoriated by an unsympathetic media, despite both doctors and the general public supporting the right of patients to access assisted dying. With his blessing, Gonzalez became a cause célèbre, but others are less inclined to go public with their plight. “Sensationalism is the worst for our work,” said Mendoza-Vega. “It tends to make what we do a spectacle and a circus. That’s the worst for objective discussions.”

I asked him for his views on the Dutch and Belgian models.

“I think in Belgium and the Netherlands they are acting according to their society’s beliefs and attitudes. Those attitudes are not the same as in the society of Colombia or in Latin America. So we must have our own ways and positions about this. We must have in mind the beliefs of our people and their attitudes.”

I often wonder what New Zealand’s attitudes are in relation to assisted dying. To me, assisted dying appears completely consistent with the stereotypical Kiwi values of rugged independence, tolerance, fairness, personal responsibility, and individual freedom and choice. In fact, those values are not too far from the ones listed in the manifestos of our two major political parties.

After spending time reviewing Seymour’s bill, I believe it is consistent with those values, while being a sensible Kiwi approach that learns from overseas experience. In particular, the proposed legislation doesn’t favour one method of assisted dying over another, leaving that entirely up to the individual, and what the doctor is willing to do. There are five permitted methods in Seymour’s bill: ingesting the medication oneself, orally, via a tube or intravenously; or a doctor supplying the medication via a tube or injection. By allowing all of these approaches, the legislation avoids hair-splitting about what is moral and what is not, and leaves it up to the patient and the doctor as to what their conscience will bear.

But no matter the method, the legislation is in keeping with New Zealand’s identity as caring and compassionate, by requiring an individual to be under medical supervision when any steps are taken to have their life ended.

Dr Anne Turner is helped by her son Edward from the Dignitas clinic in Forch, Switzerland. The retired British doctor had been diagnosed with progressive supranuclear palsy, a degenerative neurological disease for which there is no treatment. Her late husband, Jack, died of a similar condition, multiple systems atrophy, in 2002. Turner travelled to Switzerland from the UK, where assisted dying is illegal, and ended her life with medical assistance from Dignitas in March 2006. Photo/Getty.

Alongside the End of Life Choice Bill, New Zealand has been tightening its laws around assisted suicide. The Harmful Digital Communications Act was passed in 2015, amending parts of the Crimes Act to make inciting, counselling or procuring another person to commit suicide illegal, even if that person doesn’t end their life. The amendment doesn’t distinguish whether this is done electronically, as has been alleged in the case of MP Sarah Dowie’s text message to Jami-Lee Ross, or in person.

The conversation between doctor and patient around end-of-life choice is a tightrope. Under the previous law, a doctor coercing a patient into assisted dying would be unambiguously illegal. Now, under the amended act, a patient doesn’t even have to act on the suggestion for a doctor to be liable. Opponents fear that making assisted dying legal will have doctors pushing it on vulnerable patients, but it stands to reason that if a patient hasn’t asked, then it doesn’t fall under the End of Life Choice Act and may be a prosecutable crime under the Crimes Act, particularly if the suggestion is unwelcome and made persistently.

Even in a socially liberal country like the Netherlands, the conversation is a very careful one. Dr Rob Jonquiere is a former GP and current executive director of World Federation of Right to Die Societies. I met him in Amsterdam in a quiet cafe on the edge of the harbour. He has had these conversations with dying patients a few times.

“It is still, for most doctors, the most difficult request they can get, the patient asking the doctor for his help. Every doctor will immediately get in a kind of fighting stance and say, ‘Let’s see what we can do to make things more bearable.’”

I mention the arguments from some sectors of the disabled community: that doctors may unilaterally decide that a life is not worth living and may encourage someone suffering a severe disability to seek assisted dying. (Seymour has recently suggested amending his bill to state explicitly that disability is not a sufficient criterion on its own for assisted dying, although this was always implied.)

“I cannot imagine a decent Dutch doctor talking a disabled person into euthanasia. There is, of course, a possibility that in the communication between a doctor and a disabled person, which many times is a very close relationship, the doctor gets more and more the impression that actually the disabled person doesn’t accept his or her life anymore, and wants to do something about it but doesn’t want to talk about it. Then I can imagine that somewhere in that communication as a doctor, you carefully bring up the subject – not as a fact of ‘I’m going to do it’, but as a possibility they can think about.

“I would imagine that if you applied euthanasia to a patient who was disabled and reported it to the review committee, you would be immediately picked out and your case seriously scrutinised for possible referral to a prosecutor.”

Opponents have pointed to a lack of prosecutions in the Netherlands as suspicious: either the law is working perfectly with its system of oversight and review, and doctors are working within the law, or it isn’t, and doctors are quite literally getting away with murder.

But despite a lack of court hearings, cases have certainly been referred to prosecutors and health inspectors. Jonquiere estimates between 10 and 15 cases were referred every year for the past 10 years for violations of the carefully detailed procedure. However, despite the referrals, prosecutors have not elected to bring a case against the doctors named, usually because the infractions were bureaucratic oversights, not because something had gone drastically wrong.

Just last year, however, a doctor was prosecuted for not following the procedure outlined by the law – the first Dutch prosecution since assisted dying became legal in 2002. It’s alleged an elderly dementia patient had previously asked for assistance to die, but when the time came, was unable to clearly express her wish to the attending doctor. According to the claim, the doctor enlisted the help of the patient’s family to gently restrain the patient, in order for the life-ending medication to be administered. Dutch procedure states the patient must reaffirm their wish clearly at the time they are being assisted to die.

The case highlights the complexity of allowing advanced directives: a written document that specifies what you want from your end-of-life carers ahead of time. Do you respect the wishes of the previously competent individual, or the non-competent individual suffering from dementia, whose instinct to survive has set in?

“This is one of the big issues in the Netherlands... The first thing is we put in our law that an advanced directive is legally equal to an oral request when you are not able to put forward an oral request. Which means at the moment of euthanasia, you don’t need the patient to say, ‘I want euthanasia’ if there is this advanced directive saying, ‘I want euthanasia.’ You can say things have been completed in the proper way.

“[But] the doctor giving euthanasia wants to look his patient in the eye and say, ‘Is this really what you want, because if I push the needle, it’s over. No return.’ And the big issue is, if you have a demented person, is this what they want? What is the value of the answer?

“We introduced in the Netherlands the concept of five minutes to 12... As a doctor and patient, you have to talk regularly, and you have to find out actually the point where the dementia is far enough but not yet too far, so that you still can say, ‘I want euthanasia.’ And it is so far that the doctor can still clearly identify the situation as suffering, that is the moment, at five to 12, one to 12, just before 12. If you are after 12, it is too late.”

I tell Jonquiere that I think this is a very fine line, and it is part of the reason I don’t support advanced directives for euthanasia. Seymour’s bill doesn’t, either. For me, there can be no question of competency, no question that there is a real, genuine request.

“It is a balancing act,” he concedes.

Still, the recent prosecution supports the case that there is sufficient oversight. Jonquiere agrees: “Things happen which should not happen, but that happens everywhere. And I even dare to say they happen more often in countries that do not have a law.”

The evidence supports Jonquiere’s claim, especially in New Zealand. In 2000, Dr Glynn Owens, a professor (now emeritus) of psychology at Auckland University, conducted a survey of 1000 New Zealand GPs to determine the prevalence of physician-assisted dying in this country.

The research found that 3.5% had provided at least one physician-aided death at some point in their career, a similar percentage to the Netherlands, where aid in dying is lawful. Also, in the New Zealand survey, 2.7% of physicians admitted to having aided death without the explicit request of the patient. This may have been through palliative sedation, withdrawal of life support, or possibly something more ominous. Strictly speaking, terminating life without consent is involuntary or non-voluntary euthanasia, i.e. murder. And that is not legal anywhere in the world – not in the Netherlands, not in Belgium, not in Switzerland and certainly not in New Zealand.

Worse, the proportion of these types of cases was higher in New Zealand than reported in the Netherlands. The survey also found the availability or non-availability of palliative care had no effect on the physicians’ decisions to act with intent to hasten death.

The incidence of these involuntary physician-assisted deaths has reduced in the Netherlands and Belgium since legalisation of assisted dying. Are life-ending acts without patient request still happening in New Zealand? We don’t know. We don’t do any sort of reporting that would tell us. It’s the sort of thing doctors will only admit to in an anonymous survey.

Even opponents would have to concede that the End of Life Choice Bill, with its system of checks, balances and reviews, would give us much more information about end-of-life practices in New Zealand than we have now.

Trust in Dutch doctors is similar, if not a little higher, relative to other countries. An International Social Survey Programme collected data between 2011 and 2013 and found public trust in doctors was the highest in Switzerland, at 83%. In the Netherlands, the figure was 78%, while in Belgium it was 74%. In the United Kingdom and France, where assisted dying is not permitted, the figures were 76% and 75% respectively.

Dr Rob Jonquiere, a former GP and current executive director of the World Federation of Right to Die Societies. Photo/Andrew Warner/NewspixNZ.

Despite being the face of the right-to-die movement, Jonquiere has only helped a handful of people to die as part of his role as a general practitioner.

“I have assisted only two. I know three more I didn’t need to assist, because they died before the final request came, and I think about five or six did not even go into that phase. They had a request, but I could make the suffering bearable, or I had other reasons to say no. I had discussions with those two patients for three to six months before euthanasia was complied with.”

Did anyone ever change their mind? How did you feel about that?

“I feel okay. Because I act from the principle that you are the one who wants it, not me. I’ve had it happen only once. I can’t remember that I was happy about it or not. I know from that one time, two days later I practised euthanasia [on the patient]. It was just a moment where the patient said, ‘I’m not yet ready.’ They needed a moment of contemplation or realisation about what was really happening. That is why I want to know just before giving the injection – is this what they want?”

I asked how it felt to help someone to die.

“In none of the cases have I had any feeling of regret. One of the moments, I can even remember the smell of when it happened. It makes a big impression. I’ve always felt afterward, on the one side sorrow, because I lost a dear friend. Because talking to a patient about this kind of intimate, very personal issue, you get a kind of relationship, and you lose that relationship because the patient died. On the other hand, [I felt] a kind of happiness, that I could provide my friend with the last intimate wish they had. I had a couple of times where I dreamt about it. But I didn’t have sleepless nights. I had no second thoughts afterward.”

I wondered aloud whether some doctors do. “Certainly there are doctors who do and for that reason stop practising euthanasia. But they don’t say it’s a bad thing, they just say they cannot cope with that situation.

“You have to know someone. If you come to me, I’ll say, let’s talk about it. Come back tomorrow and we’ll sit down and have a serious talk. In a harsh way, you have to convince me that you are really suffering and I’m going to try and convince you that you’re not hopelessly suffering.”

I wonder whether those conversations are missing in New Zealand, and whether people who are contemplating a hastened death, for rational or irrational reasons, are talking to their doctors about it.

One of the reasons I’m in support of this law is so these conversations might happen more often. We are all afraid of dying, and when faced with it, we have wishes about how it might happen, and where it might happen, and with whom. But if your doctor isn’t going to listen to your desires – all of them – and take them seriously, why would you even have the conversation?

It’s my hope that with assisted dying as an option, the most desperate of us will discuss those wishes with their doctor, rather than doing something drastic and impulsive, which can only hurt our loved ones and our communities. Given 5-8% of suicides in New Zealand are people with grievous illnesses, perhaps with assisted dying we can help them live a little longer. Perhaps we can actually reduce the incidence of suicide in New Zealand. I believe it’s worth a try.

In a few months, we will find out whether our elected representatives will support that view. It is clear that current efforts to address suicide in New Zealand haven’t been working. It’s our national shame. But anything that encourages more people to talk to their doctors about death has got to help. And in my view, the End of Life Choice Bill will encourage exactly that.

Let’s hope our MPs boldly walk toward the light – and the bill passes.

Matt Vickers is the author of Lecretia’s Choice (Text Publishing). For more information, visit lecretia.org.

This article was first published in the April 2019 issue of North & South.

Royal College of Physicians goes neutral on assisted dying

Philip Patston — Thu, 21 Mar 2019 20:43:40 GMT

The results of the Royal College of Physicians survey are out - with the College announcing that they will adopt a neutral position on assisted dying.

This means they will join the Royal College of Nursing in dropping their longstanding opposition to assisted dying. RCP President Andrew Goddard says "adopting a neutral position will mean that we can reflect the differing opinions among our membership. "

The proportion of respondents who thought the RCP’s position should remain opposed dropped, while those who thought the RCP should be supportive increased by a significant amount. Similarly, fewer than half of doctors said they were personally opposed to assisted dying, while those who would be personally in favour increased.

We welcome this significant step in the campaign, which demonstrates that our profession is willing to engage properly with the debate. Most importantly, our patients feel very strongly about having the choice of an assisted death, and this result shows our greater willingness to listen to them. Do share Dignity in Dying's press release with colleagues and friends. Palliative care specialists were the only section of the RCP membership to recommend an opposition stance by a majority. A group of five palliative care doctors has anonymously written an article for the BMJ to welcome the RCP survey and call for a “climate of open and fair discussion in our speciality where doctors do not fear being criticised, ostracised, or worst of all – having their careers threatened."

An enormous thank you to everyone who completed the survey and encouraged colleagues to do so. Many new members have joined HPAD's ranks in 2019, increasing our membership to well over 2,000 healthcare professionals who support choice at the end of life for our patients. Today's result proves that we have strength in numbers - do please continue to encourage colleagues to join HPAD so that we can ensure all the Colleges adopt a stance that represents their members' views. The Royal College of GP's are next in line to survey their members (due later this year). The pressure is increasing on the BMA to revisit their opposition.

Today's outcome is important for the medical profession and for our patients. It allows us to start engaging in a healthy and informative debate. Our patients are clear about their wish for the option of assisted dying. It is our duty to listen to them.

Thanks again for your support,

Dr Jacky Davis
Chair of Healthcare Professionals for Assisted Dying (HPAD)

Esther's story

Philip Patston — Wed, 20 Mar 2019 20:12:49 GMT

Originally diagnosed late 2012 with a Grade 4 Geoblastomer Multiforma Tumour, I have had my brain cancer return after a four and a half year battle to beat it, followed by two years of remission. Due to the side effects from the first round of aggressive treatment, I was left disabled and live with daily pain.

With it now back, I am not able to do any further treatment, which means this will end my life.

Due to the type of cancer it is, this is a slow painful death as it on its own doesn’t kill me, instead it causes all of my body functions to shut down one at a time. This would leave me bedridden, and suffering from bed sores and everything that goes with that.

For me the passing of this bill would bring relief, and I would apply for it. However, like most overseas where they have this choice, I wouldn’t take it until the very last minute. My life would only be shortened by up to two weeks - the worst at the end.

And I would die in my own bed, surrounded by my memories and loved ones - listening to my favourite music. Holding my son’s hand (and with my faithful companion beside me on the bed) while I slip into sleep and then stop breathing.

I don’t actually want to die as my previous battle shows. However as a Christian, I am not afraid of death, just what I will be forced to go through before this comes.

Will I pass the strict conditions for application? Yes, I have a terminal illness and will apply when my doctors estimate I have six months or less to live; AND yes, it is irremediable and involves grievous suffering; AND yes, I am mentally competent and fully aware of what I am asking for. Three ticks (as required).

Unfortunately for me my previous treatments have also shown that I am in the approx 6% of people that painkillers don’t help and the last thing I want to do is die while in an induced coma (known as palliative or terminal sedation where they actually kill you by removing your feeding and fluid tubes) as that would not stop the pain, just my ability to tell people about it.

Do you think I am the only person in this position? Do you think that perhaps one day it could be you or someone you love facing this before dying? So please support this bill and vote YES.

Read a story of a good death here »

Press Release: Doctors support assisted dying

Philip Patston — Fri, 08 Mar 2019 01:36:05 GMT

Thursday, 7 March 2019, 4:38 pm

Press Release: David Barber

Seventeen doctors who say too many New Zealanders die in severe pain and suffering have written to all MPs urging them to vote for a law change to allow medical assistance in dying (MAID).

Parliament’s Justice Select Committee is due to report on ACT leader David Seymour’s End of Life Choice Bill this month after considering a record 37,000 submissions.

Dr Jack Havill, of Hamilton, spokesman for the group, said it wrote to MPs in order to counter a campaign by opposing medical practitioners who are trying to sabotage the bill. He said the “Drs say No” campaigners had emailed every medical practice but obtained only 800 signatures from the country’s 15,000 registered medical practitioners since it was formed in 2012.

Dr Havill said the number of doctors supporting MAID exceeded the 37% in favour, with 11% undecided, revealed in a survey by the NZ Doctor magazine last year.

Ten of the doctors who wrote to MPs are retired. Dr Havill said: “It is a difficult issue and many practising doctors in favour will not express their views publicly because it is currently illegal.

“They do not want to be classed with the approximately 4% of doctors who break the law to help patients die in their final illness – according to two Auckland University studies.”

Dr Havill, a retired intensive care medicine specialist and past president of the Voluntary Euthanasia Society, said enough doctors were in favour to ensure that MAID would work effectively in New Zealand. International experience showed the number would grow after a law change, he said.

One doctor who signed the letter, retired GP Carol Shand, of Wellington, told the MPs: “My years in general practice, unable to support the requests of many patients for assistance in dying, have left me ashamed of myself, my profession and our NZ law.”

Rowan Stephens, a former GP from Auckland, said: “I carry a lingering guilt into retirement knowing that I was not always able to best serve my patients at the end of their life, due to the law. I failed in my duty, and did cause harm.”

The End of Life Choice Bill passed its first reading in Parliament by 76-44 votes in December 2017. Seymour has amended it so that if it passes its final stage, a law change will be subject to a binding referendum at next year’s general election.

OPEN LETTER TO ALL NZ MEMBERS OF PARLIAMENT: Doctors say ‘Yes’ to Medical Assistance in Dying

Philip Patston — Fri, 08 Mar 2019 00:38:18 GMT

Reports from Palliative Care Australia, providing assessments made by the clinicians themselves, show that even in hospice, at least 6 percent die experiencing severe pain and severe suffering from other symptoms. These include suffocating or choking to death or drowning in lung fluids, all of which induce terror. We’d be foolish to imagine the statistics are much different here in NZ. On this evidence alone, assisted dying must be included among the options available for end-of-life care and David Seymour’s End of Life Choice Bill must be supported.

Among opponents is the ‘Care Alliance’ which includes a group of medical practitioners, including some palliative care doctors, attempting to sabotage the EOLC Bill. It is emailing every medical practice in the country and inviting doctors to sign up to its charter ie ‘Drs say No’. However, since its formation in 2012, it has achieved only 800 sign-ups out of the 15,000 registered medical practitioners ( this is well under 10%).

In a 2018 survey done by NZ Doctor 37 percent of New Zealand’s doctors declared support for the legalisation of Medical Assistance in Dying in terminal illness, with 11% undecided. As has happened in other legalised jurisdictions, supporting numbers will grow once a law allowing Medical Assistance in Dying is in place.

Medical Assistance in Dying is a difficult issue for many NZ doctors, as at the moment it is illegal, and if in favour, they are circumspect about expressing their views publicly in case their patients and colleagues get the wrong idea. They don’t want to be classed with the approximately 4% of doctors who illegally help people to die in their final illness (2 repeated studies from Auckland University).

However, the doctors contributing to this document (part of a larger group) believe it is time to make their support for Medical Assistance in Dying clear, so that the public and MPs understand why there are many doctors in favour.

Some quotes from a group of doctors supporting ‘Medical Assistance in Dying' include:

Gary Payinda (Emergency Medicine Specialist)

‘The public needs to know that many doctors out there support medical assistance in dying. At the end of the day, my own reason for supporting it is pretty simple: if I was dying a miserable death (and some deaths truly are miserable, despite the very best palliative care), I would certainly want a caring doctor to be able to help me end my suffering. And if I'd want that option for myself--isn't it only fair that my patients would have that option too?"

Alastair Macdonald (Renal Physician)

I completely echo the comments made by Gary. There is a gentle pragmatism to these important sentiments.

Dr Libby Smales (Grief Counsellor and experienced Palliative Care and Hospice doctor)

‘I have been thinking about this issue a lot recently, after decades working as a Hospice doctor, when I left, I realised:

1) I had been working in a therapeutic bubble that was not and still is not available to every dying person.

2) Even in that privileged situation, some deaths would have been truly horrible without terminal sedation.

3) in the world outside the bubble things were and still are very different,

4) I have some sympathy for my Hospice colleagues who are so fiercely anti, like them, in my arrogance and ignorance, while I was ‘’ín’’ I believed that H/PC could and did, fix all of it for everyone, I had to get ‘’out’’ to see the truth.

5) I think we have it round the wrong way, we shouldn’t have to justify this overdue legislative change, the reasons for compassion and change, are well researched and compelling, I think the anti’s need to justify why not.

Stanley Koshy (General Practitioner)

‘There has never been a better moment to get into legislation an act as significant as Medical Assistance in Dying. There is a government that is supportive of the motion, an international movement with more territories legislating in support of MAID, a public that has indicated a level of maturity in accepting that this is the next forward step to take, and a group of doctors who are willing to ensure that this movement does not lose momentum.

Jay Kuten (Psychiatrist)

A good death is to be seen as a consequence of and an extension of good palliative care.’ ‘Say Yes to Patient Choice in Dying and No to playing God and choosing for them’.

Lannes Johnson (General Practitioner experienced in palliative care)

‘I have seen many miserable deaths, in rest homes especially (private hospitals too). Home dying in more peaceful. Unlike rest homes, nobody counts the ampoules in the home environment’.

Angela Hancock (General Practitioner)

“I am baffled, saddened and concerned that so many of our colleagues are unable to consider providing the support that some patients want (and need) when the end of their days is inevitable. I am baffled that they do not uphold the patient's right to refuse treatment and palliative sedation, both often leading to miserable situations prolonging the inevitable and causing suffering. This is tantamount to abandoning patients at one of their greatest times of need in my opinion. I must support conscience decisions in this situation but I object to the obstructive "we know best" for everyone approach. I would be honoured to sign an open letter expressing support our view here and thank you everyone for your willingness to be seen and heard’.

Rowan Stephens (General Practitioner)

I carry a lingering guilt into retirement knowing that I was not always able to best serve my patients at the end of their life, due to the law. I failed in my duty, and did cause harm. My motivation is to change the law so everyone has a possibility of choice at the end of their life, and well funded hospice care is integral to this aim. Recently I decided to change out of my (morning volunteer) End of Life Choice T shirt before attending my afternoon volunteering for Hospice. Not wanting to upset any hospice supporters I was actually being cowardly.

Frank Kueppers ( Urologist specialising in Oncology) I support ‘Doctors say Yes’.’

James Davidson (Pathologist)

‘I believe that everyone should be able to choose a peaceful painless and dignified end of life, when faced with the prospect of a prolonged, painful or miserable one.’ 5 John Musgrove (General Practitioner) As General Practitioners we should provide high-quality, supportive health care for all our patients' lives. The Hippocratic Oath is always brought up when people opposed to Assisted Dying criticize the proposed legislation. I wonder if they have ever read the Oath or know Hippocrates lived over 2000 years ago. I would like to quote one of our mentors and a Senior Professor in Otago who told us when we graduated " Thou shall not kill but thou shall not strive officiously to keep alive. With the emphasis on officiously, this is what proper caring really means.

Carol Shand (General Practitioner and Sexual Health Physician)

My years in general practice, unable to support the requests of many patients for assistance in dying, have left me ashamed of myself, my profession, and our NZ law. All of us need to adopt the principle of patient autonomy which we teach to students but only partially believe in.

Miles Williams (Cardiologist) The 3rd statement of the World Medical Association Declaration of Geneva

“I will respect the autonomy and dignity of my patient” and doctors accept this unquestionably until the patient asks for relief from their suffering by medical assistance in dying. We then appear to abandon our belief in the basic human right to self-determination. Some doctors say it is unethical – it is not. Some say it puts the vulnerable at risk – there is no evidence for this. Clarity of thinking, objectivity and compassion for the individual, should replace beliefs and practice based on culture and dogma.

Jack Havill (Intensive Care Medicine Specialist)

Patients are very vulnerable as they often have to shift between home, hospital, hospice and rest home. A friend of mine, a strong advocate for assisted dying, who died from multiple myeloma in 2018, was shifted from hospice to a rest home with inexperienced staff. She was in a highly drugged state, and in her three week stay developed fractures caused by falling out of bed 3 times. This necessitated hospital admission. These last few horrible weeks could have been avoided by a law allowing medical assistance in dying. 6 In conclusion, it is clear that the general public (65-75%), in repeated scientific surveys over many years, want Medical Assistance in Dying legalised. We would encourage Members of Parliament to consider carefully the supporting evidence. One day we will look back and wonder why we allowed patients to suffer so much at the end of their lives.

Signatures:

Gary Payinda (Emergency Medicine Specialist)

Margaret Sparrow (Sexual Health Physician)

James Davidson (Pathologist)

Jay Kuten (Psychiatrist)

Lannes Johnson (General Practitioner with lot of experience in palliative care)

Angela Hancock (General Practitioner)

Rowan Stephens (General Practitioner)

Frank Kueppers ( Urologist specialisaing in Oncology)

Alastair Macdonald (Renal Physician)

Elizabeth Smales ( Palliative Care Physician and Grief Counsellor)

John Musgrove (General Practitioner)

Carol Shand (General Practitioner and Sexual Health Physician)

Stanley Koshy (General Practitioner)

Miles Williams (Cardiologist)

Alison Glover (General Practitioner/Sports Medicine)

Jonathon Baskett (Geriatrician)

Jack Havill (Intensive Care Medicine Specialist) - contact person for comments or queries - email: jackhavill@outlook.com) Cell: 021 330255

A posthumous euthanasia letter to UK MPs by Martin Hanson

Philip Patston — Mon, 04 Mar 2019 01:47:24 GMT

Source: Gisborne Herald

As in New Zealand, assisting a terminally ill person to end his or her life is a criminal offence in the UK, punishable by up to 14 years in prison. This extends to helping a person travel to Switzerland, where assisted dying is legal.

Legalising assisted dying ‘may advance’ palliative care

Philip Patston — Mon, 04 Mar 2019 01:43:32 GMT

Source: Australian Aging Agenda

The nation’s peak palliative care body is reviewing its position on euthanasia and physician-assisted dying after it became legal in Victoria, and has released two key reports on assisted dying around the world.

Friends speak out about former nun who chose medically-assisted death when faced with terminal cancer

Philip Patston — Tue, 12 Feb 2019 01:52:43 GMT

Source: Global News, Canada

More Albertans than ever before are choosing medically-assisted death. Among them, a former nun who wasn't waiting for God to decide when she died, she wanted to make that decision all on her own. Jill Croteau reports.

Lib Dem leader Sir Vince Cable calls for assisted dying to be legalised and says he couldn't let his wife suffer if her life became unbearable

Philip Patston — Sat, 09 Feb 2019 01:56:08 GMT

Source: Daily Mail, Australia

In the article the Lib Dem leader called for Parliament to introduce new laws
He spoke about nursing his first wife Olympia as she died of breast cancer
His change of heart follows Geoffrey Whaley, a terminally ill man, ending his life at Dignitas in Switzerland on Thursday

Medically assisted death in Canada: Reflections on the process

Philip Patston — Thu, 31 Jan 2019 02:01:39 GMT

Source: Rabble, Canada

This is the third part of a three-part series on medically assisted death in Canada, chronicling legal columnist Celia Chandler's personal experience with assisted dying, in the wake of her partner's diagnosis of a terminal illness.

Medically assisted death in Canada: A firsthand account

Philip Patston — Thu, 31 Jan 2019 01:59:38 GMT

Source: Rabble, Canada

This is the second part of a three-part series on medically assisted death in Canada, chronicling legal columnist Celia Chandler's personal experience with assisted dying, in the wake of her partner's diagnosis of a terminal illness.

Nurses’ views on legalising assisted dying in New Zealand: A cross-sectional study

Philip Patston — Tue, 01 Jan 2019 02:03:24 GMT

Source: International Journal of Nursing Studies

This study investigated New Zealand nurses’ views on legalising assisted dying across a range of clinical conditions, nurses’ willingness to engage in legal assisted dying, potential deterrents and enablers to such engagement, and nurses’ perceptions of the proper role of their professional bodies in relation to legalising assisted dying.

Most Kiwis support some form of euthanasia or assisted dying, Otago review reveals

Philip Patston — Thu, 01 Nov 2018 02:07:28 GMT

Thursday 1 November 2018

Most New Zealanders support some form of euthanasia or assisted dying, a review of 20 years’ research into Kiwis’ attitudes to euthanasia by University of Otago researchers reveals.

Radio NZ interview »

New Zealand is currently considering an End of Life Choice Bill. If the bill (or a modified form) passes, it would allow people with a terminal illness or a grievous and irremediable medical condition, the option of making a voluntary choice over the timing of their death. Submissions are currently before the Justice select committee, with the committee due to report on the bill early next year.

The group of Otago researchers reviewed existing research investigating New Zealanders’ attitudes to euthanasia or assisted dying over the past 20 years.

Across all surveys, on average, 68.3 per cent of people support euthanasia and 14.9 per cent oppose legislation, while 15.7 per cent are neutral or unsure. A total of 36,304 people have been surveyed.

Lead author of the research review, Research Fellow Jessica Young, says the findings are consistent with international research.

“It seems that a majority of the public are open to the possibility of legislative change,” Ms Young says.

“It is less clear what forms of euthanasia or assisted dying New Zealanders think should be available, or when and how it should be accessible, though some form of regulation is expected.”

Survey questions typically ask respondents whether doctors should be allowed to assist a patient to die, at that patient’s request, where their condition is terminal or incurable and /or they are in pain.

Among studies that specifically differentiated between euthanasia (a lethal injection that is administered at the voluntary request of a competent patient by a doctor) and assisted dying (which the researchers define as when a person obtains a lethal prescription from a doctor and self-administers), support for a doctor to end a person’s life upon request was 67.9 per cent, whereas support for assistance from someone other than a doctor (eg, family) was only 48 per cent.

Overall, no differences were found between genders and results according to age appear to be mixed. Of all indicators of socio-economic status, only educational attainment was statistically significant, with lower educational attainment being associated with higher support for euthanasia. Those living rurally were found to be more supportive of euthanasia.

Support and opposition vary across health professional specialties with palliative care specialists being mostly opposed to euthanasia/assisted dying, whereas GPs are split more evenly between support and opposition.

Two important things missing from the review, Ms Young says, is research examining the attitudes of New Zealanders who are approaching the end of life, or people with disabilities.

While it is difficult to draw firm conclusions because of the variety of reporting methods, measures and parameters used within studies, it seems that a majority of the public are open to the possibility of legislative change.

The researchers’ conclude that specific research is needed to understand the views of potentially vulnerable populations, such as those with disabilities, and to evaluate which conditions and safeguards New Zealanders believe should be available.

Other researchers involved in the review were Senior Lecturer Richard Egan, Lecturer Simon Walker, Assistant Research Fellow Anna Graham-DeMello and Consultant Medical Oncologist, Dr Chris Jackson. The review was supported by an Otago Medical School Research Grant and Division of Health Sciences Collaborative Research.

Link to the paper:
https://www.tandfonline.com/doi/full/10.1080/1177083X.2018.1532915

For further information please contact:

Jessica Young
Research Fellow
Department of Preventive and Social Medicine
Email Jessica.young@otago.ac.nz

Liane Topham-Kindley
Senior Communications Adviser
Tel 03 479 9065
Mob 021 279 9065
Email liane.topham-kindley@otago.ac.nz

Voluntary euthanasia: Australia is on the move

Philip Patston — Mon, 24 Sep 2018 03:13:09 GMT

by Graham Adams

Anyone keen to see assisted dying laws passed in New Zealand will be heartened by the increasing momentum of campaigns across the Tasman.

Lecretia Seales Memorial Lecture 2018: "Assisted Dying In Practice - Lessons from Australia's Victorian Inquiry" with Julian Gardner and Tricia Malowney

Philip Patston — Mon, 24 Sep 2018 03:09:54 GMT

Philip Patston talks about disabled people and their rights

Philip Patston — Mon, 03 Sep 2018 03:14:16 GMT

"As a disabled person myself I want the choice, if I’m in unbearable pain or suffering in my life, to end it in a way and at the time that I choose. I think it’s really important my voice and the voice of other disabled people, who aren’t afraid of the End Of Life Choice Bill becoming legislation, are heard as much as people who are not as supportive of the Bill."

Doctors should ensure their patients have a good death

Philip Patston — Tue, 21 Aug 2018 03:16:10 GMT

Source: The Economist

Canada’s assisted-dying law has taught Ellen Wiebe, a doctor, the importance of having control over your final days

The doctors who think it's become too hard to die

Philip Patston — Mon, 06 Aug 2018 03:18:27 GMT

By Anna Kelsey-Sugg for Saturday Extra

Intensive care specialist Ken Hillman believes it's become too hard to die.

When his grandfather died in 1959, it was in his own room at home, with little medical intervention.

"Most people's grandfathers died at home in those days, because the general practitioner was the last medical representative in that line. If he said 'there's nothing more to offer', then there was nothing more to offer," Professor Hillman says.

Unbearable suffering can be avoided with good, safe laws

Philip Patston — Sat, 19 May 2018 03:20:05 GMT

Source: NZ Herald

After many years working in palliative care, Dr Libby Smales has seen the suffering that can be associated with dying and remains passionate about the value of good palliative care.

Why is altruism left out of the euthanasia debate?

Philip Patston — Fri, 18 May 2018 03:22:31 GMT

Source: Noted, NZ

Not wanting to be a burden is a valid reason for accessing assisted dying, writes Graham Adams, who is a cancer patient.

Enlightenment within religions

Philip Patston — Sat, 12 May 2018 03:24:28 GMT

Source: Gisborne Herald, NZ

Religion doesn’t speak with one voice. This has recently been demonstrated with Judaism and Anglicanism in the matter of assisted dying. Traditionally, the hierarchy retains the moral absolutist position of black/white prohibitions according to the tenets of its ideology. That means an absolute “No” for assisted dying.

Report shows continued strong support for EOLC

Philip Patston — Wed, 25 Apr 2018 03:27:12 GMT

Attached is a Horizon Research report similar in form to the previous one done in June 2017.

This was commissioned by EOLC and includes 4 questions which have relevance to the debate on EOLC at the moment. It shows continued strong support for EOLC with very small numbers in opposition. A great piece of information to show to MPs or doubters as to the cause.Parts of it could also be used when you are giving an oral submission.

'He was at peace with his decision': The Canadian experience of euthanasia

Philip Patston — Thu, 19 Apr 2018 03:29:46 GMT

by Sam Boyer / 19 April, 2018

Source: Noted

Paul Courvette and his wife Liana. "He was thrilled he could chose the time and place of his death," Liana said. Photo / supplied

Paul Couvrette awoke, like any other day. Except it wasn’t any other day – it was the day Couvrette had chosen to die.

He ate breakfast, like any other day. He walked his dogs on the beach, like any other day. Then, after a final dinner with family and a last glass of Scotch, the 72-year-old announced: “I’m ready now”.

He lay down on his bed with his wife, he thanked the doctor and the nurse who were about to administer his lethal injections, he told his wife once more how much he loved her. Then he died quietly and comfortably at home.

With aggressive cancer having spread from his lungs to his brain, and with no chance at recovery, Couvrette chose to die on his own terms – how and where he wanted.

In Canada, where Couvrette lived, he had that choice. In New Zealand, politicians are now preparing to vote on the same right for Kiwis.

“He was thrilled that he could choose the time and place of his death. He had no fear,” his wife of 11 years, Liana Brittain, told NOTED.co.nz. “He was totally at peace with his decision. He was very upbeat.”

In May last year, Couvrette became the first medically-assisted death on Prince Edward Island, Canada’s smallest province, near Nova Scotia on the Atlantic coast.

As New Zealand now tussles with the moral and legal arguments inherent in assisted dying, it’s worth examining how the practice has worked in other countries.

Around 2000 people died with medical assistance in Canada in the first 12 months following the June 2016 legalisation, according to a Canadian Government report released in October last year. In the first six months, from June-December 2016, Canada recorded 803 assisted deaths nationally. During the subsequent six months, however, the number jumped 47 per cent, with 1179 people choosing medical assistance for death. Even with the increase, the number of assisted deaths in Canada still represents less than 1 per cent of all deaths.

The most common medical condition that led people in Canada to opt for medically-assisted death was cancer, which accounted for about 63 per cent of cases.

The Canadian assisted death legislation is based on the “Oregon model”, named after the US state first to introduce legislation, which permits assisted death for mentally competent people with terminal illnesses who have a defined life expectancy. Seven US states (California, Colorado, Hawaii, Montana, Oregon, Vermont, and Washington), plus Washington DC, all follow the Oregon model, as does Victoria in Australia. New Zealand legislation, if passed, would likely also follow this model.

In other countries – such as the Netherlands, Belgium, and Switzerland – the law allows for medically assisted death for sufferers of depression, advanced requests for dementia patients, and for minors with terminal illnesses.

In Canada, advocacy and lobby group Dying With Dignity continues to fight for more relaxed assisted dying controls – including rights for people with mental illnesses, dementia, and for people under-18. Meanwhile, on the other side of the fence, Dying With Dignity chief executive Shanaaz Gokool said, opposition groups continue to fight in court for restrictions. It’s an ongoing battle.

“The opponents have not been quiet. Like us, they’re participating or trying to participate, in the legal cases challenging aspects of the federal assisted dying law. There are a number of anti-assisted dying petitions that are circulating, including in churches, schools and at universities. There are groups that are trying to keep patients from being allowed to access assisted dying in publicly funded facilities such as hospitals and long-term care facilities,” she said.

“As it happens, these groups are much, much better funded than we are, even though they represent the point of view of only a small fraction of the Canadian population.”

The procedure is obviously not to everyone’s religious or moral tastes. Many conservative opponents in Canada still – as in New Zealand – can’t stand the idea. But supporters believe strongly that it should be an option for an individual in pain.

“There are many, many ways you can choose consciously to celebrate the end of your life,” Brittain said. “You can also choose to have palliative care, palliative sedation, you can choose to die naturally, you can choose to voluntarily stop eating and drinking. [Assisted dying] is not for everyone … it’s a choice.”

Her husband chose “quality of life over quantity”, she said. He didn’t want to waste away, and he didn’t want to endure treatments that would restrict or ruin his final weeks or months, Brittain said.

His death – with or without medical assistance – was imminent and inevitable. So, instead of suffering for an extended period, he was able to go out how he wanted.

“A lot of thought went into it. But I can assure you – once Paul made that decision, it was like the weight of the world had been lifted off his shoulders.”

“We had this amazing celebratory 10 days prior to his procedure. [Paul’s death] was a blessing. It was so empowering for him to have that opportunity to not only die with dignity but to dictate all the terms of his passing,” Brittain said.

For Rob Rollins, the chance to opt out of his suffering and dictate the terms of his impending death, “brought him so much peace”.

Rollins, 56, of Ontario, had fought throat cancer for 18 months – but after 40 radiation treatments, chemotherapy, and throat surgery had left him unable to eat or drink, he decided he was ready. Like Couvrette, he chose to die at home, on a date and time that suited him.

“We talked about it and for him, it was something that was very important – he wanted to be able to die on his terms, no hospitals, no comas, none of that type of stuff,” said his husband John MacTavish.

And, like Couvrette, Rollins’s spirits lifted once he decided to set the date and time of his death. He set a date three days ahead: January 6, 2017.

“Once that decision was made, and things put into place, those three days were the best days that Rob had had in years,” MacTavish said. “He had total control, he was able to not need as many pain meds … We just had three of the most incredible days that just brought everything together, all of our 28 years together, and it brought him so much peace.”

Rollins scheduled his death for 11.30am. MacTavish bundled his husband up in their wedding quilt and hugged him as the doctor administered the series of fatal injections.

“Four minutes later, it was over. I have witnessed [many] deaths – friends, people I worked with, loved ones – and this was the most beautiful experience of my life, in a way, to see how it is and how it should be,” MacTavish said.

“I think [assisted dying] is the most humane thing we can do as human beings for each other. I think everybody deserves the right. In any country … it’s the right thing to do for individuals who suffer and who just say ‘enough’.”

Why the IPCA report into illegal euthanasia checkpoint is alarming

Philip Patston — Tue, 20 Mar 2018 02:32:34 GMT

by Graham Adams / Noted /19 March, 2018

Opinion.

Questions linger over the motivation for setting up a sham traffic stop to identify Exit members and exactly how often similar breaches of the law occur.

The IPCA report into a bogus alcohol checkpointthat police used to identify attendees at a pro-euthanasia meeting was finally delivered last Thursday, well overdue and seriously underweight.

Although a brief eight pages, it took nearly 18 months before it was ready for public release after complaints had been laid in 2016, and eight months after the IPCA said the report’s release was imminent.

It offers startling insights into police practice, none of them heartening. Of course, its major finding — that the October 2016 vehicle checkpoint in Lower Hutt was illegal — could not have come as a surprise to anyone acquainted with the law. It was such a flagrant abuse of police powers granted under the Land Transport Act — which restricts checkpoints to matters of land transport enforcement such as testing alcohol levels and checking car registration — that the police took the unusual step of handing themselves into the Independent Police Conduct Authority for what was widely expected to be a public flogging.

As it turned out, the report is quite gentle with the police — as, indeed, is often the way with the IPCA. Nevertheless, despite the indulgent, softly, softly approach, it is thoroughly alarming.

First, neither the Detective Senior Sergeant nor Detective Inspector who ordered the checkpoint to identify the elderly attendees at the Exit meeting stopped to consider whether it was legal. They rang their superiors, the Acting District Commander and the Area Commander, to get approval for the checkpoint shortly before it was implemented. But both failed to warn it would be illegal under the Land Transport Act (and would also not be covered by general powers to prevent suicide as permitted by section 41 of the Crimes Act). No legal opinion was sought and they allowed it to proceed.

As the report notes: “The Acting District Commander and the Area Commander should have recognised that the proposed actions were unlawful and should have advised the officers.”

Not the first time such checkpoints used?

Just as worrying was the admission by the Detective Senior Sergeant that “police have used similar checkpoints in the past for intelligence purposes”. And the five officers who conducted the bogus alcohol traffic stop also said they assumed it was fine because checkpoints had been used for gathering intelligence before.

It seems extraordinary that all the police involved — including very senior officers — either didn’t understand that the checkpoint was illegal, or didn’t bother to consider its legality, or accepted that it was de facto police policy to use checkpoints primarily for intelligence-gathering.

The authority skirts around this last possibility by noting it “is not aware of any other instances where checkpoints have been established for purposes other than land transport enforcement and have not gathered any evidence which supports this assertion. In addition, there is no police policy which supports the [Detective Senior Sergeant’s] view [that they are used for intelligence].”

This is a long way from saying it hasn’t happened before or even that it is uncommon. As Otago University law professor Andrew Geddis told Noted: “Absence of evidence is not evidence of absence.”

Police: Staff "did not intentionally break the law"

Assistant Commissioner Bill Searle, on behalf of the police, accepted the IPCA’s findings, admitting in a statement that “establishing a vehicle checkpoint to identify meeting attendees was unlawful”. But he excused the officers’ behaviour because “our staff acted in order to protect life and did not intentionally break the law”.

This indicates the police hierarchy accepts that all the officers involved did not understand they were breaking the law, because if, in fact, they did know the checkpoint was illegal they must have been intentionally breaking it.

For the rest of us, not knowing the law is no excuse, but apparently, it serves as one for the police, even though they swear an oath to uphold it.

And in what way could they be acting to protect life when they admitted they had no concerns that any of the attendees at the Exit meeting were in imminent danger of committing suicide? Turning up announced at the homes of some 15 of them, and asking whether they had a secret stash of Nembutal and about their association with Exit is hardly going to be reassuring if any one of them had, in fact, been suicidal. There seems to have been no consideration given to just how frightened and threatened many of these mostly elderly people might — and did — feel at police appearing on their doorstep.

The report’s account of the police officers’ alarm about the attendees’ well-being thoroughly stretches credulity. The Detective Inspector described covertly monitoring the Exit meeting: “It wasn’t until we heard [them] conveying all these possibilities to commit suicide… that we were of the view that the risk level had raised considerably… There was a real possibility that [someone could commit suicide] within five to seven days once they had that information.” (The report notes: “No explanation was given for how these timings had been arrived at.”)

Yet, the officers clearly knew beforehand that they were monitoring a meeting of an organisation whose sole purpose is to provide information on how to end one’s life peacefully. In fact, the Detective Senior Sergeant and Detective Inspector told the Authority that they asked for a surveillance warrant for the Exit meeting because they “suspected that some of the conversations at the meeting would be about supplying and using pentobarbitone”.

How could they be surprised and alarmed when Exit members discussed exactly that?

The Treadwell case that sparked it

The checkpoint was triggered by the investigation into the death of Annemarie Treadwell, a 77-year-old Wellington woman who died in June 2016 after taking pentobarbitone, aka Nembutal.

It led to Wellington Exit co-ordinator Susan Austen being charged with three counts of importing pentobarbitone as well as a charge of aiding Treadwell’s suicide.

Austen pleaded not guilty to all the charges, which were a result of a police operation that collected her emails and bugged her phone and her house — including recording the Exit meeting immediately before the checkpoint was set up to identify attendees.

The police claim the reason the checkpoint was set up and names taken was concern for the welfare and safety of the Exit members who attended that meeting and had nothing to do with the investigation into Treadwell’s death.

The authority noted it would be concerned if the subsequent welfare visits to the homes of the meeting attendees “had been utilised as a tactic to progress the police investigation into the activities of Ms Z [the woman they believed had counselled Treadwell before her death]”.

Yet, a Lower Hutt Exit member, who wasn’t named, commented to Stuff about the police visit to her home after she had been stopped at the checkpoint: “[The police] said they were investigating the activities of the leader of the [Exit] group. They did not explain further what they meant by this.”

Also, another of those visited, “Mr W”, told the IPCA he found the welfare visit “odd”, and stated: “I think they were there for other reasons than just about my state.”

In February, Austen was found guilty on two of the charges of importing pentobarbitone but acquitted on the much more serious charge of aiding a suicide, which carries a maximum sentence of 14 years’ imprisonment.

The jury apparently accepted the defence’s contention that simply possessing a lethal drug, whether it is intended to be used or not, could have a “profound palliative effect to reduce suffering” that may even extend life by reducing anxiety from anticipating an unpleasant death.

Furthermore, Treadwell was not only a member of Exit but also an activist for the euthanasia cause and had submitted an impassioned plea for a law change to the Health select committee looking into assisted dying. She also had written a note found after her death asserting that no one had coerced her or influenced her in any way to take her own life.

Exit International’s head, Dr Philip Nitschke, described Austen’s trial as a “show trial with one objective — to ‘send a message’ and frighten any elderly New Zealander tempted to put in place a personal, practical end-of-life plan”.

For the police to visit Exit members who attended a lunch devoted to discussing a perfectly legal act such as suicide smacks of overreach, if not a campaign of harassment or intimidation, especially as it was conducted during a time of heightened political sensitivity over euthanasia. At the time the checkpoint was conducted in 2016, the parliamentary select committee inquiry into New Zealanders’ attitudes to assisted dying was still under way.

Nitschke viewed it as a direct attempt to intimidate Exit members. And many people will not be convinced that concern for the Exit members’ welfare was the real reason for the checkpoint or the home visits. At Susan Austen’s trial, when the police said they had obtained the names of the Exit members to make sure they were okay, her supporters laughed.

Maryan Street, the president of the End-of-Life-Choice Society, which is agitating for a law change but is not associated with Exit, said last week of the IPCA report: “The finding confirmed that those stopped at the bogus checkpoint were targeted for their beliefs and lawful activism, not because of any threat to law and order or public safety.”

She asked the police to provide “assurances that [the] campaign for a law change will not be targeted with unwarranted surveillance and intervention”.

Why did the checkpoint get the green light?

Inevitably, questions were raised about why the checkpoint was authorised in the first place. Wellington human rights lawyer Michael Bott said, after the checkpoint hit the news in 2016: “It appears to be some kind of moral crusade driven from someone on top to stop people going to a public meeting to learn about Exit and their goals.”

Others at the time queried whether it had been politically motivated by those opposed to a liberalisation of the law. Act MP David Seymour asked: “There is then the question of motive. Who was pushing for this surveillance, what was their motivation, and why were the Police Minister and Solicitor-General not aware of such a politically sensitive operation?”

A spokeswoman for Judith Collins, the then Police Minister, told media the case was an operational matter for police, and directed all questions to them.

When Noted asked Michael Bott last week whether he believed the checkpoint and intrusions into the lives of Exit members were politically motivated, he replied: “I do not think a particular party was involved. But that certain senior officers are prepared to condone the unlawful detention of New Zealanders who had attended an Exit meeting does show perhaps the strength of their collective personal view about the subject matter of the [Exit] meeting.”

Professor Andrew Geddis, while concerned by the police’s illegal behaviour, identifies a wider problem. He told Noted: “There is the bigger picture of the police intruding into the homes of elderly people — many of whom will never have come to police attention before — simply because they want to consider end-of-life options. Because our law treats all decisions to end your life for any reason as being a ‘suicide’, it authorises anybody (including the police) to intervene to try to stop this from occurring.

“I think this is wrong — the law ought to distinguish between ‘suicides’ and ‘assisted dying’, which is what David Seymour’s End of Life Choice Bill before Parliament does.”

It is richly — and sadly — ironic that the IPCA report should be made public at the same time a debate is raging over the police’s pursuit policy, sparked once again by eminently avoidable deaths. A few days before the report appeared, two young people died in a crash fleeing police south of Nelson, which also killed a 53-year-old woman in another car.

Police chases saw 10 deaths in 2017, and 22 people die since 2014, yet the police stoutly defend them as essential to maintaining law and order. “Protecting life” doesn’t seem to feature. Those who die are presumably collateral damage in an overriding goal of never letting even a minor offender evade the law.

Nevertheless, we are asked to believe that the police were so concerned about protecting the lives of elderly people who were educating themselves about how to end their lives peacefully at a time of their choosing that they had a squad of police officers urgently set up an illegal checkpoint to harvest their details and visit them at home to quiz them about their association with Exit.

The Privacy Commissioner, John Edwards, investigated the collection of personal information at the checkpoint, separately to the IPCA inquiry. His report, which was also made public last Thursday, noted: “Some complainants said the visits from police made them feel uncertain about their ability to speak freely and anxious that more visits would follow.”

He concluded: “Police approached them after unlawfully collecting their information, and questioned them about a socially and politically sensitive subject. It is fair to say that the actions by the police officers caused those complainants harm.”

The matter may not end here. After the IPCA report was published, Andrew Geddis tweeted about what he would do if he had been subjected to an illegal checkpoint: “Well, if I were one of those stopped, I'd be getting my lawyer to ask the police how much they’re going to give me for breaching my [NZ Bill of Rights Act] rights ... and readying a class action if they aren't forthcoming.”

Disability Commissioner's claim "laudable in an ideal world"

Philip Patston — Fri, 09 Mar 2018 02:38:06 GMT

Disability Rights Commissioner Paula Tesoriero condemned the End of Life Choice Bill claiming that “Before the country legislated choice in death, it needed to work towards ensuring, to the greatest extent possible, all people had the same freedom of choice in life.”

That’s laudable in an ideal world, says EOLC's Ann David, and we should undoubtedly strive to improve the lives of people with a disability. But to insist on perfection for one group of disadvantaged people before we can begin to address the wrongs committed against another group of disadvantaged people is ridiculously unjust.

Many people with disabilities support assisted dying legislation. Also, the Bill has nothing to do with disability but everything to do with irreversible, escalating, extreme suffering that cannot be palliated by any means.

Instead of torpedoing the entire bill, Paula Tesoriero might have proposed useful amendments. For example: “Disability alone will not constitute eligibility for assisted dying”.

She might also have considered what tests currently apply for the presence of mental competence and the absence of coercion when a patient requests cessation of life support or when doctors offer terminal sedation. Answer: None official. By comparison, the End of Life Choice Bill is safer for people with disabilities.

Disability Rights Commissioner’s role to ensure equality of choice — diversity expert

Philip Patston — Fri, 09 Mar 2018 02:35:27 GMT

Internationally recognised diversity consultant Philip Patston has questioned Disability Rights Commissioner Paula Tesoriero’s stance on the End of Life Choice Bill.

In an email to Tesoriero, Patston challenged her statement that, “We must first work towards ensuring, to the greatest extent possible, that all people have the same freedom of choice in life before we consider legislating choice in death.

“It’s my role to reflect the concerns of the disability community and what I am hearing is that there are significant concerns about this Bill.”

Patston, who worked for the Commission between 1994 and 1998, suggested that, as Disability Rights Commissioner, “your role as Commissioner is to ensure disabled people are not treated differently on the grounds of disability.

“Surely,” said Patston, “your role is to ensure disabled people have the same choices as other Tangata o Aotearoa/New Zealanders. This needs to include the right to choose dignity in dying.”

Named as a top 10 diversity consultant in the Global Diversity List in 2015, 2016 and 2017, Patston agreed that legislative safeguards need to be in place, to prevent coercion and to ensure informed consent and appropriate assessment.

“But this is important for the very wealthy, the very poor, and others, including people with terminal illness.

“There are many vulnerable groups, not just those who experience disability.”

Imagine, mused Patston, if we stopped all people driving cars because some people crash and kill themselves and/or others. “I'm sure there would be outrage about the infringement of rights to drive, even though it may be wrongfully lethal.”

As he said in my affidavit in support of Lecretia Seales’ case, Patston believes we land in dangerous territory when we try to protect one group by denying the rights of another. Both disabled people and those with terminal, incurable, illness deserve the right to choice and autonomy.

“My voice and those of many other disabled people who are not afraid of assisted dying and have trust in a fair, compassionate, good-willed society, need to be represented in this important, democratic conversation,” Patston said.

Ends.

CONTACT:

Philip Patston
Managing Director
Diversity New Zealand Ltd

Phone +64 9 376 4830
Mobile +64 21 764 837

Email philip@diversitynz.com

Group of doctors urge colleagues to read EOLC Bill

Philip Patston — Fri, 09 Feb 2018 02:39:29 GMT

It is desirable that medical practitioners read the End of Life Choice Bill as it is quite likely that legalisation of voluntary assisted dying may have occurred before the end of 2018

This opinion piece has been submitted by 10 retired and working doctors - Jack Havill, Libby Smales, Dame Margaret Sparrow, Lannes Johnson, Angel Hancock, John Musgrove, James Davidson, Alison Glover, Stanley Koshy and Frank Kueppers. Further details of the authors are provided at the end of the article.

The End of Life Choice Bill (David Seymour) has now passed its first reading by a large majority (76 for, 44 against). The select committee is part of the justice select committee, all members of which voted yes to the first reading.

Repeated scientific polls of the public over the years have shown increasing numbers supporting voluntary assisted dying, now 75-80 per cent supportive (Horizon Poll May 2017), so even if a referendum is held, it is likely the vote will support legalisation of a law to enable voluntary assisted dying.

It is desirable that medical practitioners read the bill as it is quite likely that legalisation of voluntary assisted dying may have occurred before the end of 2018.

Some parts of the Bill and related issues are discussed below and interested doctors are invited to participate in a group who support End of Life Choice in principle.

The End of Life Choice Bill (EOLC Bill) defines a person eligible for voluntary assisted dying as someone who:

Is aged 18 or over
Suffers from a terminal illness likely to end their life within 6 months, or has a grievous and irremediable medical condition
Is in an advanced state of irreversible decline in capability
Experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable
Has the ability to understand the nature and consequences of voluntary assisted dying

Two medical practitioners must agree that the criteria are met, and the second doctor must be independent of the first.

The director-general of health will establish a group of medical practitioners known as the Support and Consultation for End of Life In NZ (SCENZ) Group. This group will maintain a list of medical practitioners, specialists in mental health, and pharmacists willing to participate in voluntary assisted dying.

The group will be responsible for allocating the independent medical practitioner, offer advice, and replacement where the medical practitioner has a conscientious objection to providing this service. The group will write standards of care, provide advice on medical and legal procedures, and provide practical assistance where required.

Procedures for voluntary assisted dying will include ingestion of the prescribed drug in the presence of the doctor, or a direct injection of the drug if the patient wishes.

What do doctors and nurses think of voluntary assisted dying?

The limited evidence we have from surveys of New Zealand doctors is that 35-50 per cent support voluntary assisted dying. [1], [2], [3]

The NZ Nursing Organisation (70,000 members) has a position statement supporting voluntary assisted dying, as does the Australian Nursing Federation. Surveys have indicated that 65-70 per cent of nurses in New Zealand are supportive of voluntary assisted dying.

Formal evidence is only part of the picture, and anecdotal evidence suggests that many doctors are neutral or supportive, but fear admitting this openly in the current organisational climate.

Opponents of voluntary assisted dying suggest doctors are not at all supportive and should keep out of the area of assisted dying due to the moral problems – they are there to cure the patients! To many doctors the moral issues associated with not being able to relieve suffering in the way that the patient wants, constitute a greater moral burden (not to mention the sadness they feel), and some disobey the law and deliberately help patients die illegally. [4]

The Royal Australian College of General Practitioners now supports voluntary assisted dying as does the Australian Medical Students Association – the coming generation of doctors.

The Canadian Medical Association (2014) states that: "physicians are committed to providing high quality care at the end of life. They are also committed to maintaining their patients’ quality of life. There are rare occasions where patients have such a degree of suffering, even with access to palliative and end of life care, that they request medical aid in dying. In such a case, and within legal constraints, medical aid in dying may be appropriate. The CMA supports patients’ access to the full spectrum of end of life care that is legal in Canada. The CMA supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying …’.

Other associations across the world are becoming neutral, or supportive, and it is obvious that there is gathering support from doctors, and this increases as legalisation occurs and doctors realise that voluntary assisted dying can be part of excellent care to the patient.

The relationship between doctor and patient

Some argue that voluntary assisted dying will destroy the relationship between the patient and the doctor. All the evidence is against this.

Katherine Morris (Surgical Oncologist, New Mexico, USA, who also worked in Oregon) describes her views in her submission to the New Zealand health select committee (2015-16): "The argument that AID (Assistance in Dying) will fundamentally change the nature of the physician/patient relationship does not make sense to me. My experience was the opposite.

"In my view, the most fundamental aspect of the physician/patient relationship is the imperative to meet the individual patient's health care needs. In this respect, the medical community does the very best that it can.

"If the medical community is not able to offer a cure, or extend life with good quality (as defined by the patient), and the patient's goal is a modicum of control over their dying process, then AID seems to represent a natural continuum of the physician/patient relationship.

"In those circumstances, AID is the physician seeking to help the patient meet their health care goals to the best of their ability."

Palliative care and hospices

GPs often find themselves in the centre of difficult treatment programmes as the patient bounces between home, hospice, hospital and resthomes. Development of palliative care and hospices in most of New Zealand has been admirable, but still has a long way to go.

It is important to know that movements supporting voluntary assisted dying, such as the End-of-Life Choice Society NZ, wholeheartedly endorse these modes of treatment and would see most patients described in the intended Bill as being helped by these services. In Oregon, most patients who have assisted death have been treated in a hospice environment.

In the Netherlands and Belgium, palliative care doctors have been some of the leaders in the voluntary euthanasia movement. [5] However, for those who think palliative care is sufficient, there are a number of issues which should be considered including:

1) Relief of suffering from palliative care - It is clear that palliative care cannot always relieve physical suffering or "existential suffering" due to loss of autonomy and dignity, and there are a number of patients who ask for assisted medical death in spite of good palliative care. Palliative care health professionals argue their techniques are becoming increasingly refined, but some patients find the prospect of dying while under sedation repugnant. Figures released from an Australian study widely quoted in 2016 show that, 10-20 per cent of patients on hospice programmes experience unbearable pain/suffering as they die. [6] Over 1000 submissions to the health select committee on assisted dying wrote about bad deaths in their relatives and friends, and many of these were in hospice. Some of these submissions were from experienced palliative care nurses and doctors supporting voluntary assisted dying. [7]

2) Patients not under direct palliative or hospice care - Libby Smales, a NZ palliative care physician, an experienced hospice doctor points out in her submission to the health select inquiry into assisted dying (2015-16), that there is a major shortage of palliative care experts in New Zealand. She also says, that even with the best palliative care, patients can have suffering deaths.

Dr Smales points out that in legalised jurisdictions where voluntary assisted dying has been authorised, mandatory referral to palliative care doctors has often been enshrined in law, which is not the case in New Zealand. Examples of this are in Belgium and Canada.

Lannes Johnson, who has extensive palliative care and general practice experience in Auckland), in his submission to the health select committee 2015-2016, points out that most patients do not die in hospice-controlled situations, but in resthomes (about 4 times as many).

He describes cases where horrible deaths have occurred because of lack of experience and entrenched attitudes about not "giving too much sedation and pain relief, in case it causes death".

3) Integration of palliative care and voluntary assisted dying - Palliative care and physician-assisted death are not mutually exclusive; the former should be universally provided at a high level, and the latter should be available as an adjunct where requested. In Belgium particularly, voluntary assisted dying has been integrated with heavily funded palliative care, and as a result the speciality of palliative care has grown enormously.

The Canadian law mandates growth of palliative care integrated with voluntary assisted dying. The recent Victorian law mandates a major increase in palliative care funding.

There are many other issues which medical practitioners have to work though, including the sanctity of life, the difference between murder and voluntary assisted dying, autonomy of patients, shifting norms in society, the mischievous claims that the aged and disabled are vulnerable to abuse in association with voluntary assisted dying, the difficulty that doctors experience in expressing their opinions when voluntary assisted dying is illegal, and moral issues usually related to religious belief.

In conjunction with an Australian doctors group who support voluntary assisted dying, we in New Zealand have set up a group of doctors who support End of Life Choice in principle. Some are retired, some are GPs, some are hospital specialists, and all are still working through the issues.

We have responded to the Gillett article on euthanasia in the NZ Medical Journal (19 Jan 2018) and sent a suggested survey to the NZMA which they could use for their members. We consult about various issues and share information about voluntary assisted dying.

If any medical practitioners wish to join this group of the contact person is Dr Jack Havill jackhavill@outlook.com. We are careful if a person wants to remain anonymous to those outside the group, and the individual’s name will only be revealed with permission, for example, as signatures to a letter. We correspond by group emails.

About the authors

Dr Jack Havill is a retired intensive care specialist, corresponding author, jackhavill@outlook.com
Dr Libby Smales, palliative care physician and grief counsellor
Dame Margaret Sparrow, retired sexual health physician
Dr Lannes Johnson, retired GP with special interest in palliative care
Dr Angel Hancock, GP
Dr John Musgrove, retired GP
Dr James Davidson, retired chemical pathologist
Dr Alison Glover, GP
Dr Stanley Koshy, GP
Dr Frank Kueppers, uro-oncology specialist surgeon

References

1. Havill J. Physician Assisted Dying – a survey of Waikato general practitioners. NZ Med J 2015;128(1409):70-71, 20 Feb 20

2. Poll of Doctors on Assisted Dying. New Zealand Doctor July 2015

3. Oliver Pam, Wilson M, Malpas Phillipa. New Zealand doctor’s and nurses’ views on legalising assisted dying in NZ. NZ Med J 2017;130(1456): 2 June

4. Malpas Phillipa, Mitchell Kay, Koschwanez Heidi. End-of-life medical decision making in general practice in NZ – 13 years on. NZ Med J 2015;128(1418):27-39, 24 July

5. Bernheim J, Deschepper R, Diselmans W, Mullie A, Bilsen J, Deliens J. Development of palliative care and legalization of euthanasia: antagonism or synergy? 2008;336:864-67

6. Wollongong University Health Services Unit – see submission by Dr Libby Smales to Health Select Committee on Assisted Dying.)

7. Dying Badly – NZ Stories, Havill and Barber. Online – see ‘Yes to Dignity’ website

Dr Jack Havill: Euthanasia would not harm doctors asked to assist

Philip Patston — Tue, 09 Jan 2018 02:41:43 GMT

Many patients simply want a good death with those they love around them and the ability to say goodbye with dignity while conscious. Photo / 123RF

Source: NZ Herald

By: Jack Havill

• Dr Jack Havill is a former intensive care medicine specialist with more than 30 years' experience of watching people die associated with critical illness. He is a past president of the End-of-life Choice Society.

Opponents of medically-assisted dying typically resort to emotive misleading language in their bid to continue denying choice to the majority of New Zealanders who want a compassionate change in the law.

Dr Paul Moon's article on Friday was no exception and by linking the state's long-gone death penalty for capital crimes with the End of Life Choice Bill currently before Parliament's justice select committee he made some bizarre assertions and does those who desire a serious debate on the issue a disservice.

He chooses to forget that voluntary assistance in dying (VAD) is at the request of a competent patient. Dr Moon suggests, without any evidence, that the psychological effects on past executioners could be the same for doctors performing VAD. It is a fact that every day, intensive care doctors and others undertake compassionate acts which cause the death of patients.

Advertise with NZME.

Let us look at some facts. People die cruel, agonisingly painful, deaths in New Zealand every day. Many suffer horribly for days, some for weeks, while others linger at death's door for months, even years, awaiting merciful relief.

Scientifically-conducted opinion polls show that at least 75 per cent of New Zealanders do not believe this is right in a modern civilised society and thousands explained why in submissions to an inquiry conducted by the last Parliament.

In moving testimony they recounted terrible tales of family members and friends dying in conditions that a number observed would provoke criminal charges if the sufferers were animals.

Parliament is not being asked to take a leap into the unknown. One-in-six Americans now have end-of-life choice in their states — California, Oregon, Washington, Montana, Vermont and Colorado, as well as the District of Columbia. VAD is legal in Canada and Colombia and in the European nations of the Netherlands, Belgium, Luxembourg and Switzerland and will be legalised in the Australian state of Victoria next year.

Oregon has allowed VAD for 20 years with no official complaint that its strict safeguards protecting the elderly and disabled are not working. The numbers accessing the law are small and only about two-thirds of those who get a prescription for a lethal drug use it. It seems that for many the knowledge that they can end their suffering if things become unbearable is enough.

The Victorian State Parliament's select committee, whose members travelled to overseas jurisdictions where VAD is legal to study the situation for themselves, talked to a wide range of people on both sides of the debate and specifically rejected opponents' oft-claimed fears of a "slippery slope" threatening the vulnerable.

The Human Rights Commission told Parliament it supports VAD in principle and the last Government's Attorney-General, Chris Finlayson, when exercising his obligation to review the validity of all proposed legislation, said David Seymour's bill would not infringe basic human rights.

It is well recognised that palliative care cannot relieve all suffering of the terminally ill and surveys show 70 per cent of New Zealand nurses support VAD. From my soundings, I estimate about half of general practitioners support a law change. (Only 20 per cent of doctors belong to the NZ Medical Association, which opposes it, and they have not been surveyed for their opinions).

Palliative care specialists who oppose VAD reject claims that doctors use morphine to end patient's lives, but other more powerful drugs such as midazolam, fentanyl and methadone are often used. Their use can lead to death, even if the doctor pretends that they don't intend this result which is known as the "double effect".

Even though palliative care cannot always relieve suffering, hospices commonly sedate persons heavily while trying, and some are even anaesthetised by the drugs, while relatives sit at the bedside hoping that death will come quickly to end their misery.

Many patients simply want a good death with those they love around them and the ability to say goodbye with dignity while conscious. That is what this End of Life Choice Bill is all about, not about misleading and emotive claims of "state-sanctioned killing".

Euthanasia: I've watched too many patients suffer, it's time to end that pain

Philip Patston — Thu, 07 Dec 2017 02:04:39 GMT

Source: Stuff, NZ

My life belongs to me. It is my own to lead as I please, as long as I do not cause any harm to others.

Continue reading »

Who speaks for doctors on euthanasia?

Philip Patston — Tue, 05 Dec 2017 02:44:19 GMT

Source: Noted, NZ

The NZMA is possibly the most influential single voice opposed to assisted dying but it represents as few as 20 per cent of registered doctors — whose opinions it hasn’t surveyed.

The doctor who took on death

Philip Patston — Tue, 15 Aug 2017 03:46:30 GMT

Source: Macleans, Canada

In an agonizing personal and professional decision, Dr. Sandy Buchman opted to help patients with their final wish. He hasn’t looked back.

VIDEO: ACT leader David Seymour says a 1 NEWS Colmar Brunton poll showing three quarters of respondents support voluntary euthanasia should be a wake-up call for MPs undecided about his assisted dying bill.

Philip Patston — Mon, 17 Jul 2017 02:33:36 GMT

Source: TVNZ