Euthanasia hearings put MPs and submitters to the testby Graham Adams
Select committee hearings on David Seymour’s End of Life Choice Bill show where politicians are well informed and where they need to come up to speed.
Watching a Facebook stream tells you quite a lot about the democratic process that you won’t discover by reading written submissions alone. Or by following the occasional reports of the hearings in the mainstream media, which are often skimpy, and sometimes skewed towards controversial testimony — if they are covered at all.
So far, the Justice select committee has posted two days of hearings on David Seymour’s End of Life Choice Bill. It will travel around the country to listen to the 3500 submitters who asked to be heard in person, but not all sessions will be streamed. Initially, the committee told NOTED, “At this stage, only Wellington sessions will definitely be streamed” but has now said it is planning to also stream the Auckland sessions on Thursday, June 28, and Friday, June 29.
The sessions are illuminating as much for the questions the MPs on the committee ask as for the positions that submitters take in their presentations. Sometimes the MPs show themselves to be very well informed and at others much less so.
Submitters get 15 minutes to speak — timed by chairman Raymond Huo’s stopwatch — and that includes questions from the MPs at the end. Huo warns submitters that the longer they talk, the less time there will be for questions.
The session with Disability Rights Commissioner Paula Tesoriero went way over time, however, with searching questions from MPs, including most notably National’s Chris Bishop and Labour’s Greg O’Connor.
O’Connor tackled Tesoriero on why she thought the End of Life Choice Bill would allow someone with an intellectual disability to be eligible for assisted dying. O’Connor said that, as a father of an intellectually disabled son, he had read the bill very carefully and he could assure her there was “no way that anyone with an intellectual disability would come within this bill”.
National MP Maggie Barry, who is strongly opposed to any assisted dying law, interjected “Yet!” — tacitly agreeing with O’Connor while also offering Tesoriero a supportive voice. Barry was, of course, also making a nod to the “slippery slope” argument beloved of opponents but roundly rejected by such august bodies as the Royal Society of Canada, which concluded in its 2011 report: “Despite the fears of opponents, it is also clear that the much-feared slippery slope has not emerged following decriminalisation.”
Tesoriero countered O’Connor by claiming that their disagreement over who would be eligible shows just how risky the bill is. Given there is a mental competency clause, however, it’s hard to see that Tesoriero’s interpretation about the intellectually disabled could be correct or even shared by many others who have actually read the bill.
Where does the medical profession sit on euthanasia?
The questions the MPs ask are sometimes revealing about what is puzzling to them and where they could be better informed. Chris Bishop, for instance, asked former NZ First deputy leader Peter Brown, who introduced a Death with Dignity bill into the House in 2003: “What is your view on what we should make as a committee of the seemingly implacable opposition from the medical profession… Putting it bluntly, there seems to be a strong divide between the public, which in almost every poll I’ve seen shows overwhelming, strong support for the principle of euthanasia, but strong opposition from the medical community.”
Via a telephone link, Brown cited nurses’ widespread support for a law change and queried whether doctors are as strongly opposed as some say. He reminded the panel that doctors already increase pain medication that hastens death, and the main difference after a law change would be that patients would get the right to request a speedy death rather than it being a result of a decision made by doctors.
What Brown didn’t mention — and what Bishop presumably doesn’t know — is that research indicates the medical profession is far from “implacably opposed” to the principle of assisted dying even if some doctors’ organisations have reservations about some provisions in the End of Life Choice Bill.
A survey last year by Pam Oliver, Michael Wilson and Philippa Malpas showed 37 per cent of doctors and 67 per cent of nurses responded “strongly” or “mostly” agreed that assisted dying should be legalised in New Zealand.
These results were echoed in a Horizon poll, published in New Zealand Doctor this year. Thirty-seven per cent of doctors who responded supported a law change to allow medical practitioners to assist someone who has end-stage terminal disease, and is in an advanced state of irreversible decline with unbearable suffering, to die. Nine per cent neither supported nor opposed.
The impression that doctors are strongly opposed has come mainly from the vocal opposition of the New Zealand Medical Association over many years. Indeed, in 2013, Peter Brown told me the most influential opponents of his bill were the NZMA and the Catholic Church.
Since then, membership of the NZMA has fallen and it now covers only about 20 per cent of the 14,000-odd registered doctors in the country, which means it has a very weak mandate to speak on behalf of doctors.
And no one knows what NZMA members think about assisted dying because although it has polled them, it hasn’t made the results public. It’s hard not to conclude that the poll didn’t overwhelmingly support the NZMA’s adamantine opposition because it’s almost certain we would have been told if it had.
The fact that many of the major medical bodies are neutral on the topic of assisted dying — primarily because of their members’ disparate views — is further evidence that medical professionals are far from united in opposition.
The Royal New Zealand College of General Practitioners — which has 4800 members, representing nearly 90 per cent of GPs — announced in March that it had adopted a neutral position on assisted dying, although it has voiced its disquiet with several aspects of the End of Life Choice Bill and presented many recommendations to improve it.
The Royal Australasian College of Physicians — with 25,000 medical specialists and trainee specialists from 33 different specialities, across Australia and New Zealand — noted in its written submission to the Justice select committee, “There is diverse opinion within the RACP membership on medical assistance in dying.” The college is in the process of deciding on a formal position — which its draft position statement indicates is also likely to be neutral.
The New Zealand Society of Anaesthetists (600-plus members) acknowledges in its written submission that there is “a diversity of opinion within the profession on the ethics of euthanasia, and it is the position of the NZSA that this should be an issue for the personal conscience of each of our members, within the framework of the law.”
The Royal Australian and New Zealand College of Psychiatrists (with 500 members in New Zealand) is also neutral, stating in its written submission: “The RANZCP neither supports nor opposes the proposed bill but seeks to provide commentary on potential omissions we have identified.”
In its testimony to the committee hearing, its representatives acknowledged that a “huge range of individual views” exist in the psychiatric profession.
Pushing for a for-or-against position
Nick Smith, however, is clearly not keen on neutrality as an option with regards to the bill in front of the committee. He has repeatedly asked organisations presenting submissions to take a position for or against it, on the grounds that lawmakers need to vote one way or another in Parliament.
When pressed by Smith, the College of Psychiatrists’ representative eventually said a law change wasn’t “necessary” because pain — both physical and spiritual — could be managed, but then admitted there are “always exceptions”.
It’s hard to understand why Smith wants these organisations to take a position when a neutral stance is the only responsible one for a representative body that knows its members hold a wide range of opinions.
Smith also badgered the Disabled Persons Assembly to make a call, despite the fact its representative, Henrietta Bollinger, had said its members were divided.
Definite answers are not always easy to get to other questions either, as Maggie Barry discovered when she asked Peter Thirkell, the head of the Care Alliance, about the pair of lions euthanised this month at Auckland Zoo, and whether the action was humane or inhumane.
Thirkell avoided answering the question directly but said the SPCA had told him animals were usually put down for convenience, to “make the lives of the owners easier”.
Presumably, Thirkell, who is deeply opposed to assisted dying, wasn’t willing to admit the lions were put down out of compassion because that would resurrect the perennial question of why animals are often given more humane treatment than humans when they are suffering terribly.
Where is God in the euthanasia debate?
But if the lions get a look in, God struggles to make his presence known. Despite the large number of religious groups represented at the hearings so far, God and scripture are almost entirely missing in action.
In fact, there are so many religious or quasi-religious organisations making submissions that when representatives of the Humanist Society of New Zealand appeared before the panel to represent the half of the nation who have no religion, or beliefs about an afterlife, it seemed revolutionary and remarkable. Unremarkably, the humanists were in favour of a law change.
Religious groups often focus on the plight of the “vulnerable” but we hear very little — for obvious reasons — from the group that is the most vulnerable of all: those who are dying or are suffering so grievously that they would rather be dead.
For many of these people, attending the public hearings or even making a phone call to the committee is likely to be beyond their physical capabilities, and even if the law is changed it won’t come in time to spare them their suffering.
It’s worth remembering that while hypothetical harms to the “vulnerable” are being debated regularly at the select committee, real harms are occurring right now to those who are suffering unbearably.
Examining the palliative care argument
Not that you would guess that from the picture presented to the panel by Wellington palliative care specialist Dr Sinead Donnelly. When Greg O’Connor asked whether she had cared for patients during her career who repeatedly and consistently asked for help to die, she asserted none had. She said that patients might say, “This is really hard. I wish it was all over,” but once their “cry for help” was investigated, it could be dealt with so the patient’s anguish was resolved.
O’Connor seemed sceptical — and well he might be given how many people have related stories of loved ones effectively being tortured to death by their own bodies, even under expert palliative care.
Dr Donnelly gave evidence to the High Court in 2015 during Lecretia Seales’ case. It led palliative care professor Michael Ashby to write in his affidavit to the court: “While palliative care can attempt to address pain, physical symptoms and psychological and emotional issues, it cannot address all suffering in all situations. I note that Dr Donnelly alone asserts that palliative care will not allow a ‘cruel’ death and states she had never seen an undignified death. This does not accord with my experience and does not appear consistent with the acceptance in affidavits from other palliative care specialists that palliative care cannot address suffering in all circumstances.”
Justice David Collins — after hearing evidence from New Zealand and overseas palliative care experts both for and against assisted dying — concluded that palliative care was no panacea. “Palliative care,” he said, “cannot necessarily provide relief from suffering in all cases.”
It would be reassuring to know that all the MPs on the committee were acquainted with these sorts of facts. Perhaps wider public scrutiny resulting from the hearings being streamed will also encourage them to challenge submitters’ dubious assertions more often.
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