Some words grab your attention. Take “lethal”, which you can find in the End of Life Choice Act. The Act is being reviewed by the Ministry of Health, and as choices don’t come any more serious than life or death you’d think this would be done as carefully as possible. But the Ministry is rushing through its review, and even that’s too slow for some. Without waiting for the outcome, the ACT Party has lodged a member’s Bill that would make more people eligible for euthanasia and assisted suicide.
The campaign to expand eligibility has been building for a while, and alongside the rhetoric about compassion and choice you’ll find the people motivated by a fear of a so-called “dementia tsunami” and others calculating the cost differential (euthanasia is a lot cheaper than actually treating illness).
In our work with doctors and lawyers, we’ve consistently heard three main concerns about expanding access to euthanasia.
The first is that the current law is already flawed. Here are just a few examples. The Act is based on patients being free to make their own decisions, but coercion is notoriously difficult to check. The Act concedes this when it says only that doctors must “do their best” to ensure patients are not being pressured into choosing assisted death.
The Act also says that a Review Committee is supposed to meet regularly to consider assisted death reports and direct an investigation into any concerns about failure to follow the law. But that Committee didn’t meet for several months from late 2023. No medical procedure works perfectly, so where is the scrutiny we need to detect wrongful deaths?
All of this is happening while people already struggle to access necessary care and the health system is under chronic constraints. For example, we need more organ donors, and documents we obtained under the Official Information Act reveal that Health NZ and organ donation services are enthusiastic about “creating a clinical pathway to facilitate donation of organs and other tissues following assisted dying”. It’s not hard to see where that could lead.
The second main concern we hear is that extending the law would amplify these issues and introduce new problems.
New Zealand currently allows euthanasia where someone has a terminal illness “likely” to end their life within six months. Health NZ already tells doctors that “likely” just means a more than 50 percent chance, and the ACT Party bill would remove the six month limit. That extends potential eligibility to a patient with a 50.1 percent chance of dying from their illness at some indefinite point in the future.
That is a significant expansion, one that would also make our law much more like Canada’s. They allow euthanasia where someone has a “serious and incurable” illness. That’s not an identical provision, but we’d be moving more in their direction, where euthanasia deaths have grown rapidly. In 2020, they amounted to 2.5 percent of all deaths, accounting for 7,500 Canadians and representing a growth rate of 34 percent on the previous year.
There’s no reason to think we won’t see other extensions proposed, because laws that allow euthanasia are based on an idea that’s hard to contain—that some lives are not worth living. This is the third main reason for concern that we hear. Once you’ve bought into this idea, there’s no reason to limit euthanasia to cases of terminal illness, or even to limit it by age. Canada originally limited euthanasia to cases where death was “reasonably foreseeable” but removed that limit in 2021. Other jurisdictions that introduced assisted death for adults have extended it to children—Belgium did this in 2014, and the Netherlands has allowed the euthanasia of newborn babies since at least 2005.
The idea that some people, in some situations, are better off dead is depressingly familiar to people with disabilities. It’s why Liz Carr, the actress and disability advocate, says that “giving the option and the right [to die] to a group of people puts another group of people at risk”. What begins as an option becomes an expectation, that people whose lives involve some suffering or require some dependence or who are otherwise treated as a burden should take the route marked ‘end of life choice’.
The majority of New Zealand health practitioners oppose assisted death in principle even since the Act was passed, and very few doctors have registered with the Ministry as assisted death providers. That should tell us something—perhaps that the way to respond to suffering is to equip doctors to provide the best possible care for it.
In fact, the more we increase access to euthanasia and assisted suicide, the less reason we have to invest in that care, to fund new treatments to fight illnesses, or to welcome people with disabilities as full members of society.
Expanding the End of Life Choice Act would make a bad situation worse, and offers us more of the same decision we already have to make. Will we spend our limited time and resources striving to provide more care, or more killing?
This article was first published as an opinion piece in The Post, The Waikato Times, and The Press on 11 October 2024 under the heading, "The lethal risks of rushing the review of End of Life Choice Act".
