Why not just allow the choice for others and don’t do it yourself?
The principle of personal autonomy, or choice, is core to the functioning of a free society. Our laws that relate to the end of life already demonstrate a respect for personal autonomy. For example, patients have a right to be fully-informed and make decisions about their care and treatments, as well as the right to refuse treatments, even if that refusal means that the patient will die.
While it is right and proper that we have autonomy over decisions about our medical care and treatment, the exercise of our autonomy can only stretch so far. As we’ve been forcefully reminded recently, sometimes our personal autonomy to make certain decisions needs to be limited for the safety of ourselves and others. When laws change, they change the paradigms and cultural norms we all live with. A change like this to our law takes an action (assisting in someone else’s suicide) that was once criminal and unthinkable under any circumstances, and makes it allowed and enabled in some situations.
To say that legislating assisted dying won’t affect you if you don’t want it is simplistic and reductive. It’s like saying “if you don’t want to use methamphetamines, just allow the choice for others and don’t use it yourself.” We live in communities, families, and relationships, and the choices of individuals can’t be easily sealed off from affecting others.
Our choices are messages about what we think is the right course of action, and these have an effect on everyone in our communities, whether they are currently feeling resolute or vulnerable.
Does the Act reduce the risk of pressure or coercion from other people leading someone to ask for euthanasia or assisted suicide?
Coercion, which can include threats and pressure to take an action that would not otherwise be taken, has been regularly debated by proponents and opponents to the End of Life Choice Bill.
Proponents argue, for example, that the Act’s requirements for the medical practitioner to “do their best to ensure that the person expresses their wish free from pressure from any other person by conferring with other health practitioners who are in regular contact with the person; and conferring with members of the person’s family approved by the person”, are sufficient to protect against abuse.
Multiple medical organisations, including the Australian and New Zealand College of Anaesthetists, however, submitted that coercion can be subtle – especially for patients who are in pain, confused, and vulnerable, and who are concerned about the ability of doctors to identify this.
Ensuring competence and freedom from pressure is an incredibly difficult thing to do. That is, measuring someone’s competence to ask for assisted dying of their own volition (without pressure or coercion) is not just about asking the right set of questions and filling out a form. Pressure can be subtle or indirect, and at the very least, detecting coercion requires a long-term and strong doctor-patient relationship, where the doctor has an understanding of the patient’s family, cultural, financial, and social context. And yet, international experience shows us that often this is lacking:
- In 2019 doctor-patient relationships prior to an assisted death in Oregon had a median of just 14 weeks, with some patients having known their doctor for only one week. This is despite requiring 15 day “cooling-off periods” between their first and second requests for the drugs. The End of Life Choice Act does not include this requirement.
- In Washington 50% of doctor-patient relationships were less than 6 months in 2018, and again some patients only knew their doctor for a week before being prescribed lethal drugs.
These short-term relationships cannot allow medical practitioners to form a relationship strong enough to detect pressure from family members or others on the person who is requesting to be assisted to die. The End of Life Choice Act contains no features that would allow us to prevent similar results here in New Zealand.
If it’s “my body, my choice,” why should the Government be allowed to limit or remove our choice to be assisted to die?
As a society, we already limit our choices so that we can best protect others. For example, we cannot lawfully choose to drive above the speed limit, to sell ourselves into slavery, or to possess methamphetamines. When considering the risks and wider social effects that such decisions and actions could pose to other individuals or to the rest of society, Parliament has been justified in limiting personal autonomy.
 New Zealand Bill of Rights Act, s. 11: Right to refuse to undergo medical treatment.
 End of Life Choice Act 2019, s.8.
 “Submission to the Justice Select Committee,” (Australian and New Zealand College of Anaesthetists, 2018), 4, http://www.anzca.edu.au/documents/final-anzca_submission-to-end-of-life-choice-bill.pdf, accessed 6/04/2020.
 IG Finlay and A Carlile, A Question of Public Safety, 6.
 Oregon Public Health Division, Oregon Death with Dignity Act; Data Summary 2017, 11.
 Oregon Death with Dignity Act 1997.
 End of Life Choice Act 2019.
 Washington State, 2018 Death with Dignity Act Report, 12.