Submission to the Justice Select Committee from the New Zealand Catholic Bishops Conference

We strongly oppose the End of Life Choice Bill. We make this submission on behalf of the many Catholic people of Aotearoa New Zealand concerned about this Bill. We note the significant presence of Catholics working in rest homes, and hospices and hospitals, who accompany the dying and their families and whanau daily. Our history of supporting the vulnerable and the elders stretches back to the signing of the Tiriti o Waitangi where Bishop Pompallier was confidante to many Māori rangatira.

We submit that the End of Life Choice Bill is not in the best interests of the people of Aotearoa. In this submission, we will summarise our concerns about euthanasia and assisted suicide and then make some brief specific comments about this deeply flawed Bill.

A summary of our position on Euthanasia and Assisted Suicide

• Strong Māori membership of Te Hāhi Katorika (the Catholic Church) in Aotearoa from its outset in Aotearoa to this day gives us an insight into the heart, soul and kaupapa of this nation.    

• The Catholic Church’s long involvement in the hospice movement and pastoral care of the dying and their families provides us with strong credentials to speak in societal debates about dying and death. 

• The factors that contribute to the desire to end one’s life are complex, and include grief, different forms of depression, social isolation, neglect, fear, loss of hope, and a sense of being trapped.

• Like the dedicated practitioners of palliative care - doctors, nurses, social workers, counsellors, caregivers, and chaplains - we know from our experience of walking with the dying that a fearful, vulnerable, powerless person - religious or not - can be brought, with good holistic care, into a peaceful place where pain is controlled, their circumstances are dignified, and family and whānau relationships can be healed, if necessary, and enjoyed prior to death.

• The argument that those opposed to the legalisation of euthanasia and assisted suicide do not have to use it narrows the issue down to a matter of individual choice, and ignores the societal effects of the legalisation which will be experienced by everyone, particularly vulnerable groups. It is also an abnegation of the responsibility of the kaumātua (including politicians) of a nation to protect its citizens and their well-being, and undermines one of the prime functions of law which is to uphold the moral and ethical standards of a community in the interests of the most vulnerable.

• International experience repeatedly confirms that, despite claims to the contrary, legalisation leads to normalisation and the expansion of eligibility, either legislatively or in practice. Euthanasia and/or assisted suicide will introduce a new and negative dynamic into the doctor-patient relationship. To bring this upon our nation would be a disgrace and cause of deep shame.

• We believe New Zealand is independent and courageous and historically we have led, not followed, other nations in giving strength to the voiceless (women’s suffrage). To be truly progressive we must challenge ageist attitudes and eliminate the sense that being sick or old or dependant equates to being a burden.  

Some specific Issues with the ‘End of Life Choice Bill’

The Bill puts older New Zealanders at greater risk of being abused. In determining eligibility for assisted suicide, the Bill makes no room for an assessment of a patient’s inherent vulnerability or any rigorous assessment of whether or not the patient is being subjected to pressure. Our society has become increasingly aware of the prevalence of the abuse of the elders. During Elder Abuse Awareness Week in 2017, we heard tragic stories of elder abuse including that of experienced social workers describing the not uncommon experience of decision-making being assumed for our elders: “Sometimes families are accidentally abusive. They take over so the older person doesn't have to make decisions about their finances or life, but they leave the victim feeling powerless and frustrated.”[1] Elder abuse continues to rise, despite laws designed to prevent it. If the law is incapable of preventing such abuse currently, then it follows that the End of Life Choice Bill will not prevent abuse.

The Bill’s eligibility criteria are open to interpretation and subject to “bracket creep”.  The Bill provides a pathway to early death which relies on patients making subjective self-assessments of their suffering which arises from physical, mental disability, chronic illness (including mental illness) or terminal illness. Proponents of the Bill talk about ‘safeguards’ but international experience confirms that what in fact happens is an ongoing expansion of parameters surrounding eligibility – a phenomenon referred to as “bracket creep”. A 2010 Report on Euthanasia in Belgium by the European Institute of Bioethics, a not-for-profit group of doctors, scientists and jurists found that: “Initially legalised under very strict conditions, euthanasia has become a very normal and even ordinary act to which patients are deemed to “have a right”. In the face of certain high-profile cases, the evident relaxation of very strict conditions has caused many reactions, but also a total absence of any sanctions on the part of the Commission (Belgium Health Commission) and a very conciliatory silence from the political establishment has given rise to a feeling of impunity on the part of some concerned medical practitioners, and a feeling of powerlessness in those worried about where things are leading.”[2]

The Bill would contradict the Government’s pledge to better support mental health. The End of Life Choice Bill makes it legal for those with a mental illness to have a doctor assist their suicide. There is strong consensus that we need a fresh approach to a mental health crisisand we agree with the Prime Minister that “we all know we have a problem with mental health in this country and our suicide rate is shameful. It is well past time for us to do something about it[3].” Sections 10-12 of the Bill, which deals with medical opinions, does not require a psychological assessment of the patient requesting euthanasia to be undertaken.  All that is required, at most, is a decision by the medical practitioners about competence.  A person suffering from depression or anxiety can be deemed competent to make a medical decision, despite the illness they are suffering from.

The Bill does not belong in medicine. The Bill offers an impoverished view of health care with no requirements for doctors to have any expertise or experience in palliative care or mental health or experience or expertise in the patient’s condition. Palliative care and hospice services are of a high standard in New Zealand and they can be expanded to give patients the choice of quality end of life care.

The Bill turns medical practitioners into administrative robots.The Bill requires doctors to follow an administrative checklist which leaves no room for the kind of professional judgement required in complex end of life situations.The Bill takes a dim or even cynical view of the medical profession by seeing doctors as men and women who complete set tasks in a prescribed or identical manner for each situation. It seems that the Bill, in fact, seeks to bypass the professional input and analysis of doctors. Patients are best served when professionals use their specialised knowledge and training to assess evidence and make judgements that inform treatments.

The Bill restricts the conscience rights of doctors. We are also deeply concerned about the Bill’s apparent requirement for a doctor with a conscientious objection to advise a patient that they can contact the SCENZ Group and therefore act to connect the person with a doctor who will carry out the process of assisted suicide. This action restricts the conscience rights of medical practitioners that protect robust professional judgement and prevent doctors from duress. Clause 7 is a gross violation of an individual’s exercise of personal professional integrity.   

Conclusion

Our consultation and dialogue with people, from young people in our large network of schools to treasured elderly - from tangata whenua on our katorika marae to new migrants’ groups, from people serving our nation in rest-homes, hospitals and hospices to friends in other faith communities and none - all lead us to conclude resolutely that the passing of this Bill would be unethical, dangerous and unprogressive. Our whānau, our Pasifika, our Asian peoples, and our Pākehā all know we can do better.

78% of the 21,277 submissions to the earlier select committee were against a change in our law. While some popular polls claim that New Zealanders are in support of the Bill, many commentators note that in fact what they are expressing is a view on a misunderstood notion of “choice.” We are also aware of research which shows that support for assisted suicide significantly drops off when some of the practical implications are included in polling.

The End of Life Choice Bill is a giant step backwards. As the nation delights in Prime Minister Jacinda and Clarke’s news of a baby, we urge that the nation move forward, showing the same delight and respect for our elders and all other vulnerable lives too. We call on the New Zealand Parliament to protect the vulnerable, the mentally unwell, the disabled and the elderly. We call for a strengthening of support for palliative care facilities and hospices.  The first Labour Government of this nation saw the need for “care from the cradle to the grave”. In a contemporary manner, may compassion, not fear and threat, continue to stand at the heart of our nation. 

Bishop Patrick Dunn, Bishop of Auckland and NZCBC President

Bishop Charles Drennan, Bishop of Palmerston North and NZCBC Secretary

Cardinal John Dew, Archbishop of Wellington

Bishop Steve Lowe, Bishop of Hamilton

Bishop Paul Martin SM, Bishop of Christchurch

Bishop Colin Campbell, Bishop of Dunedin