The End of Life Act is Just the Beginning
In countries where euthanasia has been legalised, laws have rapidly been subject to a much broader interpretation than originally intended. Laws originally written to offer a legal right to die to those terminally ill people with unbearable suffering have expanded to include mental illness, disability, and even children.
There is justifiable concern that passing the End of Life Choice Act in New Zealand will lead to liberalisation of the law over time. We can see from the examples of other countries that legalising euthanasia is the beginning of inevitable and undesirable changes in our culture.
The Netherlands and Belgium were the first two countries to legalise euthanasia, both taking effect in 2002. By looking at the original intentions of their laws, and how the interpretation has widened over the last 18 years, it is clear that the legalisation of euthanasia creates an opening for significant consequences down the road.
Whilst not surprising that instances of euthanasia increase after legalisation, what is concerning is the rate at which it increases. In the first year of legalisation, Belgium attributed 235 deaths to euthanasia. In 2018, just 16 years later, this had increased ten-fold to 2,357 deaths – the equivalent of more than 6 per day. And in the Netherlands, last year the only euthanasia clinic in the country reported a 22% jump in requests compared to the previous year – 13 people requesting euthanasia every day. These cannot simply be attributed to more people becoming aware of the option of euthanasia, as it has been available for some time. The deeper issue is the significant cultural shifts which allow euthanasia to be used more readily as a response to ever-wider categories of suffering.
In some countries where euthanasia is legal, people are able to access it for reasons solely of mental illness or disability. The original law in Belgium held strict conditions for patient eligibility for euthanasia, with the intention of stopping secretive practices that were already occurring and ensuring legal safety for both the patient and the health practitioner. Within just a few years the law had expanded to include mental illness, non-fatal diseases, and future possible suffering as justifiable reasons to choose death.
Examples of this abound. In 2009, the criteria for “unbearable” suffering due to “accidental or pathological illness” was expanded to include non-fatal pathologies, including reduced mobility due to arthritis, blindness, or loss of hearing. In 2014-2015, there were reported cases of euthanasia for non-terminal patients for reasons including dementia, depression, schizophrenia, autism and bipolar disorder. Further interpretation of the law decided that “future dramatic developments” would be considered as “unbearable suffering”; so the law now included what might happen in future as a reason to consider euthanasia.
One of our grave concerns regarding the New Zealand End of Life Choice Act is that it is vague and does not provide enough guidance. If a more strictly worded law such as the one in Belgium so quickly expanded to be much more liberal in application, what could that mean for us in New Zealand?
In the Netherlands, conversely, the ‘law’s directives are few and broadly drawn’ with a study in 2019 citing cases such as a healthy Dutch woman who was euthanised one year after her husband’s death due to “prolonged grief disorder” (study here). This year the law was expanded so that doctors can no longer be prosecuted for euthanising patients with dementia, after a doctor was acquitted of wrongdoing for euthanising a 74-year-old patient who had to be held down as the lethal dose was administered.
In both the Netherlands and Belgium, euthanasia for children has been introduced as part of the increasingly wide criteria of their laws. In 2014, Belgium widened their criteria to allow for terminally ill children – with no age limit – to have the option of euthanasia with parental consent. In the Netherlands, the law allows for those ages 16 and up to choose euthanasia without need of consent, while children as young as 12 are eligible with parental consent. In 2005, three years after legalisation, euthanasia of infants was decriminalised.
What is clear is that whether laws are more strictly worded, or with fewer directives, international precedents are for them to be inevitably interpreted in an increasingly liberal way, and often for the law itself to change. Given that this has been the pattern in all jurisdictions which have legalised assisted dying, there is no reason to doubt that this will be the progression in New Zealand too.
Our proposed Act is already broad. It does not require physical pain, parental consent for a young person, a mental health assessment, or for patients to try any other treatment options first. It will open the door to a rapidly evolving law to include instances that currently seem inconceivable, but which have become normalised in other countries. The wise approach would be to keep that door firmly closed, and to pour our resources into other, safer end-of-life care.