If the End of Life Choice Bill being considered by Parliament’s Justice Select Committee passes into law as it is currently written, the long term result could be an estimated 1247 deaths per year under such a regime in this country.
That is the projection of the UK think tank Living and Dying Well (a secular body), which has sent a memorandum of evidence analysing the Bill to the select committee.
Submitted under the name of the think tank’s director, former senior Whitehall civil servant Robert Preston, the memorandum uses data from The Netherlands (where Physician-Assisted-Suicide (PAS) and Physician-Administered-Euthanasia (PAE) occur) to arrive at the New Zealand figure (this was also based on the figure of 31,179 deaths in New Zealand in 2016).
The memorandum noted that in 2016, one in 25 of all deaths in The Netherlands was the result of PAS or PAE. The Netherlands experience was considered as the most applicable to what would happen in New Zealand out of countries which have such regimes.
This is because The Netherlands has both PAS and PAE– and both of these would be permitted by the End of Life Choice Bill (even though the Dutch law and the Bill are worded differently), and there are at least 15 years of data from Holland upon which to draw conclusions.
The memorandum also noted that of the 6091 deaths attributable to PAS and PAE in 2016 in The Netherlands, 96 per cent were the result of PAE: only 3.5 per cent were the result of PAS.
Mr Preston also estimated what would occur in New Zealand, based on the reported figures from the US state of Oregon, in which PAS (but not PAE) is legal under certain circumstances.
The figure of projected New Zealand deaths if this country followed Oregon’s example (i.e. PAS only, not PAS plus PAE) then dropped to 124 a year.
“Why is there this difference between the two procedures?” the memorandum asked.
“One explanation is that PAS, which requires an applicant for ‘assisted dying’ to self-administer lethal drugs, requires more determination on the part of the individual than does PAE, where the doctor is the active participant and the patient occupies the role of passive recipient.
“Another is that the direct involvement of a doctor in the act of bringing about death via administration of intravenous injections presents the process as a clinical and best-interests procedure and PAE as being analogous to a general — though in this case permanent — anaesthetic. The reality is different: PAE consists of two injections — a deep sedative to put the patient into a coma, followed by a muscle-relaxant, such as curare, to bring about death from asphyxia.
“Whatever the reasons, there can be no doubt that legalisation of PAE alongside PAS has the effect of driving out the latter and of resulting in much higher death rates.”
The memorandum’s key argument was that “any law to legalise ‘assisted dying’ must pass two tests. It must demonstrate that the existing law is defective; and, if (and only if) that is so, it must be constructed in such a way as to ensure that it does not put vulnerable people at risk of harm, including self-harm”.
“In our view”, stated the memorandum, “the Bill does not pass either of these tests”.
The memorandum’s arguments ran for some 6000 words, dealing with the existing law and its effectiveness, the prospect of harm to the vulnerable if the law was changed along the lines of the Bill and other factors such as the role of doctors.
On the first point, the memorandum argued that: “The existing law has the teeth to deter criminal behaviour while also having the discretion to deal appropriately with genuinely compassionate situations.”
“It may not suit everyone — no law does that. But the purpose of the law is not to offer options and choices to some but to protect society as a whole, and especially its most vulnerable members, from harm — including self-harm.”
“The existing law has a stern face and an understanding heart,” the memorandum continued.
“But that is a completely different matter from creating a licensing system for acts of assisted suicide and administered euthanasia. It is this change in the dynamic that is almost certainly a major factor of the rising numbers of such acts in those jurisdictions where legalisation has taken place.”
In terms of protecting the vulnerable, the memorandum noted that the parameters set by the End of Life Choice Bill for who would qualify for PAS or PAE are very widely drawn.
“They include people with serious and long-term chronic illnesses, such as MS, Parkinsons, diabetes and heart disease, as well as people with conditions such as cancer with relatively short trajectories to death. There can scarcely be a street in New Zealand where there is not someone who might qualify in one way or another.”
A “surprising and critical omission” from the End of Life Choice Bill is that “nowhere is it stated in the Bill that to qualify for ‘assisted dying’ an applicant must be acting voluntarily and without pressure”.
Section 8(h) requires an assessing doctor to “do his or her best to ensure that the person expresses his or her wish free from pressure from any other person”. But the memorandum noted that, even if a doctor assessing a request is able to establish that the person making it “expresses his or her wish free from pressure from any other person”, that does not mean that no prior pressure has been applied or that the person is not suffering from internalised pressure — for example, feeling an obligation to hasten his or her death in order to remove a care or a financial burden from the rest of the family. Such feelings are common in people with serious illness.
The memorandum also queried the vagueness with which the Bill deals with the issue of “decisional competence”.
Living and Dying Well has asked for an opportunity to present oral evidence at a select committee hearing.
The full text of the memorandum of evidence may be found at www.livinganddyingwell.org.uk
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