New Zealand’s End of Life Choice Act is deficient and the assisted dying law needs to be changed says Dr John Kleinsman from the Nathaniel Centre for Bioethics.
His comments come as the Ministry of Health is conducting a mandated review of the End of Life Choice Act within three years of its implementation to assess its effectiveness and determine whether amendments are needed.
The current review will be finished by November.
Kleinsman was speaking on 1 News.
Changes needed
Kleinsman say the current legislation needs changing as it lacks:
- a formal assessment for coercion
- a requirement for an independent witness during the assessment phase
- adequate screening for depression and other mental health issues
- no cooling-off period after a request is made
He recognises that the case for assisted death is motivated by a desire to show mercy to those suffering.
While individual cases may appear justified without immediate harm, concerns arise about the cumulative impact of cases and shifting public perceptions, he says.
Kleinsman warns that the growth of habits and attitudes of mind gradually reshapes public perceptions of what is happening and what assisted dying means.
He points to several international examples that cause concern.
Countries like the Netherlands, Belgium, Luxembourg and Spain now permit assisted dying for mental illness, with several other countries also allowing it for minors, infants and individuals with dementia.
Then, in a related development, a 2023 Canadian poll revealed that 28 percent of respondents supported assisted dying for individuals experiencing homelessness, while 27 percent were in favour of those living in poverty.
The findings have fuelled further controversy as stories emerge in Canada of patients opting for assisted dying due to inadequate social support and healthcare rather than an autonomous choice driven by their medical condition.
“This shows us a glimpse into our own future if we loosen our eligibility criteria – the price could involve “severe unintended consequences” Kleinsman said.
He adds that we must continue to protect the integrity of palliative care and have AD-free spaces. Many people want this, and it’s essential for upholding real choice.
He says that to replace the requirement for a terminally ill patient’s life expectancy to be under six months with a clause like “grievous and irremediable suffering” would be wrong.
Forbidding doctors to raise the option of assisted dying with a patient must not change, he says.
Pro assisted dying changes
Social Justice NZ CEO Jackie Foster says she voted “no” at the referendum but has changed her mind.
Foster said, after losing her mother to cancer and having a close friend aged 51 die from a degenerative disease, it is often difficult for doctors to determine if people will die within six months, so she wants the removal of that time restriction.
She wants two changes to the legislation –
- the removal of the words “within 6 months” from section 5(1)(c)
- inserting a new sub-section 5(1)(g) into the Act that says “suffers from a degenerative disease that will ultimately end their life”
Foster believes that the first three years of this legislation have brought the country closer on the issue.
In 2020, 65 percent of voters said “yes” to the legislation but she believes that number would be higher today.