InterChurch Bioethics Council Oral Presentation to the Health Select Committee. 

Introduction

• The InterChurch Bioethics Council (ICBC) has existed since 2002, as an ecumenical, cross-cultural body supported by the Anglican, Methodist and Presbyterian Churches of Aotearoa, New Zealand (www.interchurchbioethics.org.nz).  ICBC members have between them considerable expertise and knowledge in science, ethics, theology, medicine and education.  Today we are represented by
• Rev Dr Graham O’Brien: Ministry Education Coordinator Nelson Diocese/Bishopdale Theological College and Co-Chair InterChurch Bioethics Council. PhD Molecular Biology, Masters in Theology and Ethics.
• Dr Helen Bichan ONZM: Presbyterian representative. Fellow in colleges of both psychiatry and public health medicine, experience in public health medicine (including international) and health administration. Foundation member of the NZ Bioethics Council.
• Mr Filo Tu: Director of Missions for the Samoan Synod of the Methodist Church. Administrator for the InterChurch Bioethics Council.
• We appreciate the opportunity to present to the Health Select Committee our oral submission against introducing legislation described as “physician-assisted dying”.

Key points from our submission

• As in our submission we believe it is important to clarify terminology in this current debate.  The terms of the petition are confusing since Physican-Assisted Dying includes palliative medicine, the withdrawal of life supporting treatments, patient choice of any treatments or withdrawals, as well as intentional assisted-suicide and euthanasia.  This term is too broad to be accurate.  What is being discussed is a deliberate intervention specifically intended to end a person’s life for the purpose of relieving distress. This is more correctly called physician-assisted suicide where the drug is prescribed by a physician and administered by the patient, or euthanasia – where the drug is administered by the physician or someone else. 

• Much of the current discussion is based on the issues of rights and choice – at present a small but vocal and persuasive group are seeking to increase control of their own choices.  However, as a society all of us are in relationship so that individual choices affect the rights and choices of others, and many of our current laws reflect this.  As a result, individual choice is tempered by wider social considerations.  A society is judged by how it treats those less-abled or vulnerable – including children, people with disabling conditions, and elderly people. Legislation that allows assisted-suicide and euthanasia will change our society forever so that the rights of the few impact the right of us all, especially the vulnerable. 

• Extension of criteria for euthanasia is unstoppable.  As international evidence shows, wherever legislation is introduced to allow assisted-suicide and euthanasia, there is an incremental extension of criteria allowing euthanasia to more groups over time; including lowering the age limit – for example Belgium now allows euthanasia for minors of all ages, the inclusion of other conditions including non-terminal conditions such as depression and other psychiatric conditions.  Recent examples are a 24-year-old sexual abuse victim in the Netherlands,[1] and a 17-year-old in Belgium.[2]  Also there is a gradual shift from voluntary to involuntary euthanasia for example dementia patients.  It is worth noting that in 2007, 32% of euthanasia events in Belgium occurred without request or consent.[3]  You might say - surely good legislation can prevent this.  The reality is “No”! Legislation cannot stop this.  Why – because if death is now seen to be a right and to be a benefit worth having - then it is a right and a benefit for all, not just for some in society. Therefore, as seen overseas, any restriction on assisted suicide is open to legal challenge and over time the numbers increase.[4]
• The best legislation in the world cannot restrict this practice.  To quote Professor Theo Boer, professor of ethics at the University at Groningen, and for nine years a Member of a Regional Review Committee in the Netherlands, “the very existence of a euthanasia law turns assisted suicide from a last resort into a normal procedure – don’t make our mistake”.[5]

• Compassion is a societal value. There are many arguments against assisted suicide that do not have a religious foundation, and there are some that have their foundation in Christian values.  One such shared value is our understanding of love and compassion. Care and compassion contained within the view of unconditional love is about doing good without doing harm, and identifies the intrinsic value and dignity to human life regardless of abilities or situation. 
• Respect for human dignity applies to each individual and also to humanity as a whole.  In this context the causing of death is seen as a harm, whereas compassion denotes walking alongside the other so as to not die alone, and where the relief of suffering can include not prolonging death.  Furthermore, there is also the preferential care for the vulnerable within society, so that our compassion and care extends to create conditions where all can flourish.  For those suffering this includes the greater availability of palliative care; research into palliative medicine; and by listening to those who speak for the ‘disabled’ so that “nothing about us without us”.

• NZ cultural inclusion: Society has become more individualistic; less tolerant of those who are less fortunate or vulnerable– the poor, the elderly, the disabled, the children.  However, the current discussion is largely a rationalist western Pakeha conversation.  Many cultures other than the majority ‘western’ culture have traditional ways of managing death and dying in family/whanau settings.  Our conversations and research identifies that physician-assisted suicide or euthanasia has no equivalent in language or practice in Māori and Pacific people practices.  Therefore, the current debate risks imposing on New Zealand cultures a largely “secular western worldview” without adequately considering other cultural viewpoints.  For many Māori the tribal custom of karanga aituā means that talk about death will ‘call it down’,[6] which could limit discussing the issue of euthanasia.  It would appear that for Māori and other Pacific people, talk of assisted suicide is seen as an ‘unnatural conversation to discuss or contemplate’.

 As Tess Moeke-Maxwell and colleagues state, “the dying and their whānau are proactive in doing whatever they can to ensure a high quality of life is achieved to enable the individual to live for as long as possible and as comfortably as possible” – “They do not give in easily to death”.[7] 

• NZ is rightly concerned about the levels of suicide among young people, and men aged between 20 and 65 where the New Zealand rates are high compared with other OECD countries.  Recently it was reported that suicide rates have reached their highest since records have been kept.[8]  “From June 2014 to May 2015, 569 people are officially listed as having died by suicide or suspected suicide – the highest number ever recorded in New Zealand.”[9]
• Do we want suicide (whether physician-assisted or not) normalised as an option when a person is in distress?  Do we want to be a society that when someone takes their own life, our response is to say “well that was their choice”? Overseas studies show that allowing assisted suicide or euthanasia does increase the rates of unassisted suicide - in the Netherlands suicide rates have increased 35% over the 6 years up to 2015.[10]

• The role of health practitioners is also central to any such law change. There is an assumption that doctors will be the ones to enact any law change.  But doctors see their calling as maintaining life, not taking life.  Any law change would have widespread and deepening repercussions for the way we understand life, and the callings and duties of the medical profession.  These are fundamental roles within society charged with caring, healing, curing wherever possible.  At our most vulnerable times – when we face death - physicians (and others) have a considerable role in the care of people through a relationship in which the real questions are addressed with patient and family, unnecessary treatment is stopped or not started, relief is provided for physical, mental and spiritual distress, and the person who is dying is supported to the end.  The intention is a dignified, pain-free death. Physician-assisted suicide and euthanasia would cut across this trusted relationship.
• My experience is that it is not easy to assess the level of a person’s depression, and the degree to which depression is distorting their view on life.  What people have appreciated is having others support them through the period of depression, and they are glad that they have not ended their lives through suicide.

Summary

• The move to allow assisted suicide or euthanasia is not a global movement of change – most western countries are rejecting such legislation.  We already have valid and excellent alternatives in NZ through palliative care and the hospice movement which can ensure assistance so that people can “die well, but this needs to be more freely available.
• Compassion includes preferential care for the vulnerable within society, to create conditions where all can flourish.  This includes greater availability of the excellent palliative care we have in NZ; research into palliative medicine; and by listening to those who speak for the ‘disabled’.
• Upholding the choice of a few will effectively take away the choice for many, including Māori and Pacific people, and the vulnerable. This will change New Zealand society now and for future generations, by sending a “better off dead” message at a time of increasing health costs and a growing elderly population.  Overseas evidence shows that narrow criteria for assisted suicide/euthanasia cannot be contained by laws.
• The key role of government is to ensure that all citizens, no matter how vulnerable, receive appropriate care without diminishing the rights of the least able.

[1] Simone Mitchell Euthanasia debate reignited by 20yo sexual abuse victim.  Monday May 16, 2016. http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11639637

[2] http://www.abc.net.au/news/2016-09-18/euthanasia-17-year-old-first-minor-to-be-granted-belgium/7855620

[3] http://www.alexschadenberg.blogspot.ca/2013/09/euthanasia-is-out-of-control-in-belgium.html

[4] The Netherlands saw a 190% increase in euthanasia from 2006-2015.  In the 10 years to 2013, the number of euthanasia cases in Belgium has risen from about 1,000 to 8,752, according to official records.  http://www.abc.net.au/news/2016-09-18/euthanasia-17-year-old-first-minor-to-be-granted-belgium/7855620

[5] http://www.dailymail.co.uk/news/article-2686711/Dont-make-mistake-As-assisted-suicide-bill-goes-Lords-Dutch-regulator-backed-euthanasia-warns-Britain-leads-mass-killing.html#ixzz475CQjW5M.  See: Boer, T. Rushing toward death? Assisted dying in the Netherlands, March 28 (2016) at http://www.christiancentury.org/article/2016-03/rushing-toward-death.  Also see Theo Boer, I supported our euthanasia law, but I was terribly wrong: Dutch ethicist.  https://www.lifesitenews.com/opinion/i-supported-our-euthanasia-law-but-i-was-terribly-wrong-dutch-ethicist

[6] Tess Moeke-Maxwell, Linda Waimarie Nikora and Ngahuia Te Awekotuku. “Māori End-Of-Life Journeys”. In Human Development: family, place, culture 2nd ed, W Drewery and L Bird Claiborne eds.. North Ryde: McGraw-Hill Education, 2014.pp. 382-383.

[7] Tess Moeke-Maxwell, et al., “Māori End-Of-Life Journeys”, pp. 382-383. Tess Moeke-Maxwell et al., “End-of –Life Care and Māori Whānau Resilience”. p. 145.

[8] JESS MCALLEN. Suicide toll reaches highest rate since records kept. Last updated 07:28, July 3 2015. http://www.stuff.co.nz/national/health/69920289/Suicide-toll-reaches-highest-rate-since-records-kept

[9] AMY MAAS. The story of one woman, a suicide note, and blind justice. Last updated 10:17, May 29 2016. http://www.stuff.co.nz/national/health/80450197/the-story-of-one-woman-a-suicide-note-and-blind-justice

[10] Aaron Kheriaty, “The dangerous contagious effect of assisted suicide laws”.  Washington Post, 20 November 2015.