The illusion of certainty in the End of Life Choices Bill
David Seymour is convinced his End of Life Choices Bill, drawn from the Private Member’s Ballot last Thursday, would be an appropriate and compassionate part of end of life care in New Zealand. I am not.
Despite Seymour’s reassurances that the safeguards included in the Bill are sufficient, reading the Bill reminds me that international experience shows that no safeguard has proven safe enough, and that legalisation of euthanasia or assisted suicide creates unreliable categories, that are subjective and easily expanded.
The Bill provides the option of euthanasia for any New Zealander, aged over 18, who has “a terminal illness or grievous and irremediable medical condition.” If this terminology strikes you as vague, you’d be right.
Terminology like “irremediable medical condition” creates two categories of people in our society.
Those whose lives we deem worthy of protection by refusing access to euthanasia or assisted suicide even if they wanted to end their life, and those for whom we think suicide might be thinkable. Creating this distinction between people we’d like to stop from trying to kill themselves, and those we would assist, is hugely troublesome.
Even advocates of euthanasia would agree that there must be categories, that some people should be prevented from accessing euthanasia or assisted suicide. But where, and how, would we honestly draw that line? Advocates for this Bill would say that these categories are clear cut, that doctors can easily determine who does have a terminal illness or irremediable medical condition and who does not. But this simply isn’t possible. Wherever you draw the legal boundary, there will always be people who end up just outside of it, and feel strongly they shouldn’t be excluded from procedures available to others. This is what leads to the “category creep” we have seen in The Netherlands, where, 17 years after legalisation, people can now be assisted in suicide because of their struggles with alcoholism and depression.
Seymour’s bill states that euthanasia would also be available to terminally ill patients, but only when they are likely to die within six months. At first glance this seems a reasonable and rigorous safeguard, but only if we can actually make these kinds of medical predictions accurately in all cases. As palliative care specialist Sandy MacLeod asserts:
In the final days of life an estimated time and date of death may become more accurate, but in the weeks and months prior this is an estimate and could be completely incorrect.
I witnessed the reality of this uncertainty when a family friend was diagnosed with cancer and given only a few months to live. More than five years later, she is in remission, has seen her kids finish school and head to university, enjoy life, work, and holidays. She is now healthy and cancer free. Imagine if such a law had been in effect when she received her prognosis.
Uncertainty and lack of control surround issues of end of life care. We want to know what it will be like, how much we will suffer and whether life will still hold value. These are important and good questions, but while many reasonable and compassionate people promote euthanasia and assisted suicide as a solution, they forget or downplay several crucial elements. They forget that life with a grievous and irremediable condition such as Alzheimer’s, a disability, or depression still has inherent dignity and worth, and that a terminal diagnosis does not always have the timeline we might expect.