WelCom December 2016:
The following is a summary of the oral submission delivered in November by Dr John Kleinsman for the Nathaniel Centre – the NZ Catholic Bioethics Centre – to the Health Select Committee Inquiry into Ending One’s Life in New Zealand. It addresses four main points.
Choices are shaped by the context in which we live
One of the arguments most commonly put forward in favour of assisted suicide or euthanasia (EAS) is that such matters are best left to individuals to choose and it is not for others, including the State, to deny such a choice. However, as a society, we routinely limit people’s choices for the sake of the common good. The key question is whether, with respect to euthanasia, there are sufficient reasons to continue to do so. We say there are.
The strongest arguments against granting the right to choose EAS arise when we understand that all choices are made within a context and that contexts can be either empowering or disempowering. We all need to be cognisant of the following features which define the current New Zealand context:
- our inability to have an open informed conversations about what a good death is;
- our healthcare and eldercare services are under growing funding pressures;
- the inability of our laws to prevent growing rates of elder abuse;
- rising rates of mental illness, including depression, especially amongst the elderly;
- the negative attitudes of many towards living with a disability or being dependent;
- rates of suicide amongst the highest in the world, including elderly;
- as many as 2000 New Zealanders in psychogeriatric facilities and residential private hospitals without consent or protection;
- inequitable access to palliative care;
- varying levels of competence amongst GPs in providing palliative care;
- growing numbers of elderly;
- the increasing social isolation of the elderly and a growing sense amongst many that they are a burden;
- increasing pressure on families and communities to carry more of the responsibility for supporting the elderly and dying.
All of which leads us to the conclusion that there has never been a more dangerous time in our country’s history to think about implementing assisted suicide or euthanasia.
The distinction between choice and autonomy
When large numbers of our most vulnerable elderly and disabled, along with their families will, for financial or social reasons, find themselves in situations where they lack real choices, it is irresponsible and unjust to provide them with the choice of prematurely ending their life.
Choice can be conformity when people have little ability to determine the conditions of consent. Competent people can easily find themselves making understandable but terrible choices out of desperation – this is not autonomy. Autonomy arises only when we have a range of real choices and are free to choose. A commitment to social justice demands we work to ensure there is a coincidence between choices and autonomy, but, where that is not possible, or until it is possible, social justice also demands we must withhold certain choices.
Because people’s lives are literally at stake, and because there is no effective redress for wrongful death, we must err heavily on the side of caution. In bioethics we use the term ‘precautionary principle’.
The precautionary principle
The precautionary principle to risk management states if an action or policy has a suspected risk of causing harm then, in the absence of empirical evidence that the action or policy is not harmful, the burden of proof that it is not harmful falls on those supporting the action or policy.
This means it is incumbent on proponents of change to provide indisputable evidence that any regulatory system would be sufficiently safe. In the absence of robust indisputable evidence, the precautionary principle means even the possibility of significant risks would require that New Zealand should pull back from introducing euthanasia.
Even when you look at the overseas data in the most positive light, it is impossible to conclude the introduction of euthanasia would NOT lead to significant risks.
Leave health professionals out of euthanasia
The original Voluntery Euthanasia Petition requests consideration of attitudes to ‘medically-assisted dying’ in New Zealand. The desirability of providing euthanasia needs to be considered separately from the question about who the agents might be.
It is dangerous to assume euthanasia belongs within medicine and, besides, it is incorrect to think we could only have a euthanasia regime if it involved health professionals as the agents. From a bioethical perspective we argue euthanasia is fundamentally incompatible with the very core of the medical and nursing professions.
Consider that we have faith in our justice system precisely because every person has two advocates – one who argues their guilt and one who argues their innocence. Just as we would never entertain abandoning that system and trusting one lawyer to represent both sides of the case, so we should never put health professionals in the position of representing the ‘life’ interests of their patients while also being the judges of their quality of life and the gatekeepers for accessing euthanasia. We would then in effect be asking doctors to be judge, jury and executioner.
The current law may not be perfect but it provides a clear bright line. Moving the bright line of prohibition would create far more problems than it would ever solve. Apart from the intractable problems of consent and coercion, moving that bright line to some new position would merely create new ‘hard cases’ on the boundary. You would not be solving a problem, you would merely be shifting it. We know from overseas jurisdictions that early safeguards or boundaries inevitably extend to include children, those with mental illness and disability and the elderly who are tired of life.
The safest way forward is to hold the current line.
[A summary of Caritas Aoteroa NZ’s oral submission is online at www.welcom.org.nz]