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Right to Die? NZ and Euthanasia

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The Sarco, developed by Exit International

The New Zealand Parliament has twice voted against a bill to allow for legal euthanasia (1995 – vote 61-29; and 2003 – vote 58-59). On Wednesday, a new bill passed its first reading (76 to 44).

What agility do we have in discussing ethics?

Leaving Roman Catholic clergy formation to one side for the moment, what percentage of priests and pastors have done any substantial academic study of ethical theories – sufficient to be able to lead their community in real reflection on this and other complex issues? I dare you: on Sunday, go up to your priest or pastor and ask: “Do you hold to a deontological or a consequentialist approach to ethics, and what do you see as being the plusses and minuses of each?”

Although many Christians conveniently silo people into such boxes as “conservative”, “liberal”, “progressive”, and “revisionist”, I have always found labelling individuals unhelpful. Contrary to such futile classifications of people, I know many who are, say, moderate about divorce, progressive about same-sex relationships, and conservative on euthanasia.

Let’s turn now to the actual euthanasia discussion.

One parliamentarian said, “My own grandmother attempted suicide a number of times when I was a child because she felt she was a burden on society”. Our response to this is, surely, not helping her to succeed in her attempts. It is facilitating our society to be more caring, and helping people to realise that each person is precious – no one is a burden.

A recent opinion piece highlights the issue in our nation which, shamefully, ranks high in the world’s suicide-rates lists:

At a time when Canterbury – and the wider nation – is rightly distressed about our shameful, unshakeable suicide epidemic and the clamour for effective mental health services, the notion of sanctioning assisted suicide seems crudely incongruous.

As the Medical Association (NZMA) points out, legalising euthanasia would saddle New Zealand with the grey area of “rational” suicides and “irrational” ones. The Care Alliance soberly warn that it would lead young people to think suicide was an acceptable response to suffering.

It is disingenuous to argue, as the author of the bill David Seymour does, that “a significant percentage of suicides in New Zealand were people who knew they were dying and wanted to take control”.

New Zealand has high-quality palliative care. This needs to be stressed, and if necessary, further resourced.

The bill is considering a procedure that looks, at least initially, to be in conflict with the oath that doctors make. We need to be clear that what is not being debated is the ethical “principle of double effect” where a physician uses a treatment, or gives medication, for an ethical and legal intended effect where the potential outcome is good (eg, relief of a symptom or pain), knowing that there will certainly be a secondary effect (such as death). This is not a debate about when we can switch off life support, or about whether to use extreme measures to extend life a little longer.

We may think we are engaging in rational debate, but how we speak (and write) about euthanasia may be significantly affecting our opinions. Look, for example, at the language: the bill is titled “End of Life Choice”. Our city’s newspaper (The Press) in the headline called it the “Right to die bill”. It is regularly called “assisted dying”. “Choice”, “rights”, and “assistance” immediately conjure up positive sentiments. Even the word “euthanasia” literally means “good death”. Let’s not underestimate the way the language we use affects people.

Churches have a much reduced influence in New Zealand. Roman Catholicism, arguably the organisation with the strongest philosophical tradition of academic study of ethics, lost its footing in 1968 when, with the publication of Humanae Vitae, Pope Paul VI (ab)used the (in principle good) Natural Law theory of ethics to decide (against the majority of his advisers who were using the same Natural Law) that artificial contraception is immoral. The majority of Kiwi Roman Catholics ignore this teaching. Furthermore, that church lost its ethical credibility through the sex abuse scandals. Its teachings on euthanasia may influence devout, practicing Catholics, but it would surprise me if its teaching had much impact beyond its flock.

Anglicanism has been embroiled for decades in debating who may love whom. This hasn’t been focusing on ethical theories shared beyond the faith community; it has been an endless argument about what biblical texts might mean for gays. None of that inconclusive (surprise!) biblical stuff is going to transfer easily to euthanasia. Certainly, quoting bible verses to a culture that mostly sees them as primitive texts with a rather capricious deity is not going to cut it in our post-Christian nation. Euthanasia isn’t even a third-millennium ethical conundrum. Heaven help us when we have to address an ethical issue new to this century.

In a world where public perception is paramount, it is fascinating that, uncontested for the last eight and a half years, the Wikipedia entry on Euthanasia in New Zealand, viewed by about 15,000 people a year, has:

The Anglican Church in Aotearoa, New Zealand and Polynesia, part of the Anglican Communion and the second largest church in New Zealand, believes that euthanasia has a place in society.

The Anglican Church, of course, has no such “belief”.

The perceptive TV series, Boston Legal, Season 2, Episode 16, dealt with a court case involving a husband ending his wife’s life with an overdose of morphine. The shock moment is when viewers realise the husband was having an affair with the nurse who provided the morphine. The programme raises questions such as, to whom does my life belong? It suggested that families often act to end their own suffering. Denny Crane, speaking about euthanising his father says, “We put him out of our misery.”

To conclude, let’s be clear what we are, concretely, talking about. If euthanasia is legalised in NZ, going by overseas rates, about 1,400 deaths a year here would be by euthanasia – about four a day.

If it is not by agility in ethical theories, nor by the teachings of churches, is the public and parliamentarian opinion to be moulded by the hands of journalists? I quote from the article I began this post with:

Jacinda Ardern said she would support the bill, but her decision should have no baring on which way Labour MPs voted.

This is a serious debate – about life and death. It requires the ability to sift through subtle distinctions (say between Natural Law and Proportionalism). Are we really going to allow such a serious debate to be primarily framed by people such as reporters and subeditors who cannot even distinguish “baring” from “bearing”?

*****

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image: from the Exit International website:

Suicide machine harnesses 3D printing technology

A high-tech ‘suicide machine’ is being touted by a euthanasia advocacy group. It’s called the Sarco capsule, and it has a single, simple purpose: to help you commit suicide, painlessly and efficiently.

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27 thoughts on “Right to Die? NZ and Euthanasia”

  1. Kia Ora Bosco. Great piece. And… clergy in Aotearoa in 2017 should be able to discuss Māori approaches to ethics as well. European understandings are not the only framing for these issues of course.
    Nga mihi, Hirini

  2. That machine in the photo looks very other-worldly cultish. I can see the authorities walking into a doomsday cult compound (Heaven’s Gate comes to mind) and finding a room full of these, lined up like pews in a worship space & aimed at a religious focal point…occupied with the dead.

    A little research states that it works by using liquid nitrogen to rapidly cool the chamber and depleting the oxygen as the occupant painlessly goes to eternal sleep.

  3. Hi Bosco,

    Placement of words is really important. I know this because my first assignment in the health and wellbeing study I’m undertaking at the moment, has been marked as incompetent! And rightly so. Luckily I get the chance to resubmit.
    As I work in community-based health, the approach that we take, is a person centred, meaning that WE are all responsible and equal to the tāngata whaiora (people seeking welling) for ensuring improved quality of life. We promote life and in the community we have pain management clinics. Medical advancement and a better understanding of now to treat ones close to death has come a long way. All you need to do to see this is visit a local rest home or hospice , Yes some are bed ridden and are near death,but most are still enjoying their life’s.People are still caring and visiting them to make should they are not alone and pain free. They also welcome anyone to come along to the course in palliative care that they run from time to time. Thanks Bosco, Blessings Ruth

  4. Thanks for this excellent reflection Bosco.

    I don’t know that it is helpful to get into deontological vs consequential theories of moral theology on euthanasia, and neither is it necessary, because euthanasia violates both.

    I expect the most popular argument against euthanasia is the inability of the supposed “controls” to actual protect people being pressurised into euthanasia or even euthanised against their will, which has happened in Holland.

    It is important to be very clear that euthanasia is not suicide. It is another person putting someone else to death. That’s killing/murder/manslaughter.

    Christians need to decide if the commandment “do not kill” really means what it says.

    Many blessings

    1. Yes, Chris – thanks for the opportunity to clarify. I wasn’t thinking of debating deontological versus consequentialist theories in relation to euthanasia. I would simply hoping that anyone seriously debating ethics is aware of the main moral theories. I far too often hear people purporting to present seriously on an ethical issue and, when pressed, the foundations can be anything from “this is what I think the Bible says” to “I feel”. It’s been a long day – and I don’t know if my comment clarifies or makes things less clear. Blessings.

  5. Ruth HendryRennie

    Hi Bosco, Your comments do indeed, clarify a clearness to understanding the topic you have kindly mentioned. Blessing to you and your family.
    and a Merry Christmas. Ruth

    1. Thanks, Ruth. It is an important and also, for many, intensely personal. We need to be able to talk about this generating light, not heat. Blessings.

    1. Thanks, Evan.

      1) I’m not sure where you are getting this from. Bill Mounce has: “Euthanasia (“easy death”) refers to a painless death, or allowing or putting to death by withholding medical treatment.”
      2) I cannot find any suggestion of any etymology of ‘euthanasia’ other than “from eu- “good” (see eu-) + thanatos “death” (see thanatology)”
      3) Even if you are correct, the point in my post is how we hear the word ‘euthanasia’ when we use it in English. Every usage, in English, of a word beginning with ‘eu’ the sense is good, positive: euphony, euphoria, eulogy, euphemism, etc.

      Blessings.

  6. ‘New Zealand has high-quality palliative care. This needs to be stressed’

    That’s good, and does change the ‘debate’ somewhat.

    America does not, we do not have a health care system here as in other countries, so everything comes down to money and what people can pull together using their for-profit insurance policies. We are told this is better than other countries because we are consumers and have choice, but there are very few comprehensive health insurance policies now where a patient has a choice of where to go for treatment. Where I live has some of the world’s best hospitals and foremost treatment procedures but I do not have access to them.

    We had health reforms under Obama, but very poorly written, so ironically a person can be too poor in most states to qualify for the insurance subsidies to enable them to buy health insurance. The program for the poor- medicaid- is not available to millions. Millions in America still don’t have basic medical insurance, and for those who do there are still lots of gaps in the coverage.

    Even the elderly program for health care- medicare- has gaps in coverage so people must buy ‘supplemental’ insurance, and there are still yearly out of pocket costs.

    So I do question for myself personally and the future what will happen when I can’t work and if I’m sick, suicide is definitely one of the options.

    It’s not a matter of ethics but of practicality.

    I have looked into all this and lived all this for a long time, and could write a book on it all, but so far as the churches are concerned, the religions, the question I would ask any religious minister who takes exception to suicide as an end of life choice: does your ministry involve visiting the sick and dying?

    Because that’s really important.

    I’m not sure that some of the younger church leaders here get that, how it makes the sick or dying person feel valued that the minister takes a personal interest in them.

    Christianity in my opinion needs to be based on looking out for the poor, the sick, the dying, the outcast. That’s what I read in the Bible and I am increasingly perplexed by capitalist-christianity which is about church being an efficient business.

    But then I feel the same about a doctor office or hospital or charity- people can lose sight of what is the most important.

    In NZ we read about the youth suicide epidemic? rather than the dying requiring euthanasia.

    My own son has talked about suicide before. The young people are disappointed, we raised them for better ideals than they are seeing. Greed has overtaken so many ideals- education, medicine, charity.

    And not just greed for money- perversion. Abuse.

    I am not as familiar with NZ politics, but when our president makes friends with dictators, jokes about abusing women and supports a pedophile…it’s got to be confusing and scary for the young men we have been raising with better values.

    1. You paint a (sadly) important picture, Tracy. In NZ, we have just had a change of government – after 9 years from centre right to centre left. We are in no way formally a “Christian” country (no politician would say “God bless New Zealand”, there’s no mention of God on our money, and the Prime Minister doesn’t every mention that we are praying for people) but I think our policies have always been closer to Jesus’ intentions than, say, USA. Why the suicide and depression rates are so high in NZ are an enigma – that’s a whole other investigation. Certainly, it is hard to know why the Christians (& clergy) don’t get the obvious things you are writing about. This certainly comes with my thoughts, prayers, and good hopes for you – with the distance, that’s really all I’ve got. Blessings.

  7. Thanks Bosco. You have always been a marvellous encourager, and distance is in our hearts and minds more than geography!

    I can always go back to England, though I wanted to stay here, I love America in many ways, and I was hoping that health care would be fixed- for myself and all Americans- it’s a major weakness and very depressing indictment on civilisation.

    Pain management has become a problem here too, in response to what the government calls ‘the opioid crisis’. One would hope that the dying who are in pain are still appropriately medicated, but many chronic pain patients are finding their medication supplies reduced or cut off, and being treated as though they have criminal intentions because the drugs they need to function are addictive.

    As you say ‘each person is precious – no one is a burden.’ In all the major religions- tikkun olum, Matthew 25, Zakat al-Fitr, charity and social action are supposed to be paramount.

    Greed is a sin, and I should want for others what I want for myself?

    The new CEO of the largest health insurance company in the US is earning over $12 million a year. For a basically useless middle-man function which could be removed and free up the profit to help people who need it. $47.5 billion US yearly profit to be exact for that single company, four times that is their global income.

    At some point capitalism stops being realistic regarding concern for human life and just becomes corruption: ‘For I envied the arrogant when I saw the prosperity of the wicked.’ Everyone joins in, people become cynical.

    Maybe that’s why so many young people are depressed and suicidal. They feel they have nothing meaningful and no one to look up to and emulate.

    The insurance company I just wrote about advertises many times a day on television, all these sentimental advertisements about how much they care. The fakeness and emotional manipulation has to affect young people, hell it sickens me to the stomach sometimes.

    ‘Anomie’ Durkheim called it in his book on suicide.

    I often wonder what I would do if God put millions of dollars my way. Would I turn my back on others and be corrupted with greed?

    Feel free to test me, Dear Lord!

    1. From many face-to-face discussions here, Tracy, it seems that pain management is well under control here. So what is left here, in some ways, is a discussion about what cannot be palliated. Blessings.

  8. You mentioned Bosco approaching the subject from the Maori perspective. What was the historic Maori concept of approaching the end of life?

    Not all Native American folks, but some, have had the tradition whereby when they felt their usefulness to their people, their tribe, their family had greatly diminished because of physical deficit due to old age and/or illness, they would choose their time and wander away into the wild on their own and face the elements and death. That is a form of suicide I think. It was certainly someone demanding the honor, the respect, of taking their death into their own hands.

  9. A physician assisted death is legal in the USA in Washington DC, California, Colorado, Oregon, Vermont, and Washington. It’s only for people with a terminal medical diagnosis. It’s still quite rare though.

    It’s fairly common for Americans to complete legal paperwork alongside a last will requesting not to be given further medical treatment where there is no hope of recovery. But I think most people would say they don’t want physician assisted death.

    The reason I believe in a legal framework for euthanasia is to prevent someone taking their life too soon, whilst they still have control of their mental and physical life and affairs.

    I don’t believe suicide is a sin, though I think it’s a tremendous burden to place on a loved one or doctor to terminate a life. And I don’t believe in the death penalty for criminals, on the other side of legally taking lives in the USA.

    ‘Denny Crane, speaking about euthanising his father says, “We put him out of our misery.” ‘

    Certainly with for-profit medicine there are ethical issues about postponing death and prolonging suffering for as long as a person has funds to care for them.

    But I don’t want to be a burden on my child, like most parents.

    Yet even as I write that I wonder.

    I had to make difficult decisions on behalf of my dying loved ones at an early age. It definitely taught me empathy and compassion and to know that sometimes life is not perfect no matter what.

    Making a meaningful adult life is about such decisions. Maybe I protect my son too much? Dis-empower him from the decisions he needs to make himself to be a man?

    I am glad you brought up suicide in any context though, it’s not discussed enough though it is the leading cause of violent death worldwide and has been called a crisis by WHO.

    1. Thanks, Tracy.

      Your points actually contrast to what is proposed in NZ.

      I haven’t time to research each of the states’ legislations that you mentioned, but Oregon was used in one of the facebook groups discussing my post and so I’m now a bit more up on that. Oregon specifically prohibits euthanasia, where a physician or other person directly administers a medication to end another’s life. So it is quite a different piece of legislation to NZ’s proposal. Furthermore, as I mentioned, we in NZ already have one of the highest suicide rates in the world. Suicide in Oregon is 42% higher than your national average. “Suicide is an important public health problem in Oregon. ..Suicide is the second leading cause of death among Oregonians aged 15 to 34 years.”

      The request you mention, of not to be given further medical treatment where there is no hope of recovery, is also not what is being discussed in our parliament – that is also allowed here, and I would say pretty normal.

      Blessings.

  10. Dear Bosco, you probably won’t agree with my liberal contention here, but I feel duty bound to offer it.

    I well remember being part of the All Saints, Margaret Street’s ‘Institute of Christian Studies’ many years ago – when (now Bishop) Fr. Michael Marshall was the Vicar. We had a very lively worshipping community in those days and part of our ex-curricular activities was concerned with the group study of ‘Christian Ethics’ – one subject of our discussion being that of ‘Euthanasia’.

    I well remember the contribution of 2 women doctors in my group who both attested to the fact that some medical practitioners (including themselves) have been actively involved in what might be termed ‘assisted dying’ – with terminally ill patients whose pain, anxiety or mental state had become intolerable for the patient – to the degree that the doctor felt the best and most charitable course of action was to provide relief that might be expected to end in death.

    This situation was not – in those days – openly spoken of; certainly not by registered medical practitioners.
    However, in the context of the group’s studies, it was thought important enough by these two doctors for the rest of us to understand that there are circumstances in which even a Christian practitioner (bound by the Hippocratic oath to preserve life) considers that to prolong treatment would be contrary to common human compassion and a direct cause of unnecessary further grievous suffering. The thought was expressed, within our group, that – if we are not willing to allow our animal pets to suffer more than they seem capable of accepting – then why would we want our human friends or companions to live through further pain and suffering?

    I might say, that we also enjoyed a talk from Doctor Cicely Saunders, the Founder of the Hospice Movement in England; whose well-known ministry to the Dying has been wonderfully perpetuated in such places as the Dorothy Kerin Foundation at Burrwood in England, which we, as a group, actually visited. We were made aware of what can be done for the Dying in that wonderful ‘Home of Healing’. However, I – amongst others who were in our group – found that we were influenced to believe that there are situations in which ease of prolonged suffering in an individual is paramount.

    It is important to reflect on the fact that suicide is no longer seen by the Church as a barrier to Christian burial. Nor should it be, IMHO.

    1. It doesn’t encourage dialogue, Fr Ron, if you begin a comment by stating an attempted prediction of the response of the other person.

      What you have described is not what is being proposed by the Bill. You are simply describing the application of the Principle of double effect which I specifically mention in the post.

      No one is arguing that what you are suggesting is being debated. No one is arguing that it should not be the case that the “ease of prolonged suffering in an individual is paramount”. Nor is anyone arguing that those who die by suicide should not receive Christian burial.

      Blessings.

      1. Sorry, Bosco, if I preempted any response from you, by my presupposition of an outlook you have not specifically stated. I merely wanted to say that the anti- ‘death with dignity view is not the only ‘Christian’ response to the N.Z. proposal. Some of us have experienced the extended suffering of a family member that we now think was avoidable.

        1. Thanks, Fr Ron.

          Clearly, there is no claim in this post that there is only a single Christian position (if there was any doubt about that, the conversations in the comments have made that clear), although the unanimous vote this year by our bishop and synod to a motion opposing euthanasia proposed in our country does indicate a strong position.

          In fact, this post is attempting something other than presenting a simply Christian position. It highlights that the Christian voice in our country carries diminishing weight, and that those engaged in this discussion need to become nimble in using ethical theories shared beyond the borders of the church. It laments our (particularly Anglican) lack of agility in this sphere.

          I highlighted that this begins by attention to the language we use. “Death with dignity” is an example of such language. Speaking of those who trust our contemporary ability to palliate pain as if this is an anti-death-with-dignity view is, I think, unwarranted.

          In the recent discussions I have had with medical experts, palliating pain is not the issue now. What is at issue is the small number of situations which are not about palliating pain. The real light-rather-than-heat discussion needs to be whether the proposed bill deals with that or whether it is a “solution” worse than the “problem”.

          Blessings.

  11. The Death With Dignity Act (DWDA) in WA State was passed by a public referendum (plebecite) in 2008. It was passed favorably in 30 of the 39 state counties and by 57+% of the total vote. The Act requires that the patient administer the dosage to end their life, not the doctor or anyone else.

    The state had defeated a public referendum in 1991 that would have allowed a physician to administer the fatal dose if the patient wasn’t able to do it for themself. That referendum was defeated by 54% of the voters.

    The DWDA has a strict set of prerequisites;
    • The patient must be an adult (18 or over) resident of the state of Washington
    • The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation)
    • The patient must be terminally ill with less than 6 months to live, verified by two physicians.
    • The patient must make voluntary requests, without coercion, verified by two physicians
    • The patient must be informed of all other options including palliative and hospice care
    • There is a 15-day waiting period between the first oral request and a written request
    • There is a 48-hour waiting period between the written request and the writing of the prescription
    • The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility
    • The patient is encouraged to discuss with family (not required because of confidentiality laws)
    • The patient may change their mind at any time and rescind the request
    • The attending physician may sign the patient’s death certificate which must list the underlying terminal disease as the cause of death

    The referendum was supported by former state governor Booth Gardener and a coalition of organizations concerned with healthcare in the state. The state’s psychological association remained neutral.

    The opposition was similarly represented, including the Roman Catholic Church and other conservative religious groups. The actor Martin Sheen appeared in anti-initiative statewide ads.

    The opposition labeled the Act assisted suicide, the suporting side countered that it wasn’t, it was a humane death for a life that was already ending.

    Gleaned from Wikipedia.

  12. Oregon would be considered one of the most ‘progressive’ and enlightened states here. ‘Death with dignity’ still does not address my concern that people must end their life too soon to be able to self-administer the drugs. But it’s still one of the few places addresses the issue or attempts to.

    I’ve been reading about youth suicide, it’s not surprising where mental health services are expensive and inadequate. It’s hard enough to get a young person to accept they need counselling without then finding it’s unavailable or too expensive.

    Last time I needed counselling I asked my doctor about it and she said ‘go to church’. I thought that response was professionally inappropriate but if all the depressed people did turn up at churches would they be able to help them?

    And what has helped me that I’ve taken from religion over the years that doesn’t comfort my son’s generation?

    Often it’s been poetry. Those special phrases we were taught to memorize and quote. It seems silly I know but I think there is strength and inspiration there which cannot easily be replicated with anything more scientific.

    And music has made an incredible difference in my life. I got a basic music education because of the laziness of my parents- they went to sign me up for classes age 14 and the ones I’d picked had longer lines so they signed me up for music! Which has served me well.

    The reasons that are given for depression and youth suicide are often poverty and hardships and lack of cultural identity.

    I grew up in poverty in a mining village, hard working class industrial environment. Big culture of functional alcoholism. I was really clever and didn’t want to work in a factory, I wanted a university education but my father refused. He said I would just get pregnant later and it would be wasted!

    Working in factories taught me a lot about endurance. It was a bully culture, and sometimes a brutal working environment- 6 am, freezing cold water, scrubbing pottery. But we were laughing and singing!

    I wanted something better for my own child, but everything comes at a price. He did not have the hardships I did, but did not have the lessons learned either. He does not have stamina.

    I do listen to him though Bosco. He tells me now it was hard for him to see me abused ( by his father ) and sinking into depression. I thought I covered all that up but clearly I didn’t.

    I do think church ministers can make a tremendous difference to their communities.

    There’s few places people get unconditional love and Christ does that.

    It’s unfortunate the abuse scandals etc. Turning young people back to the church or at least ideals of christianity is important.

    1. Yes, the Oregon approach is quite different to the NZ Bill. And it does not address those paralysed – one of the situations that cannot be palliated. Blessings.

  13. I just called my religious minister about a booking. He was too busy with his social life to talk to me about me. Good thing I’m not a young person and suicidal. I will say Bosco never once all my life have I put dinner or anything so trivial as important before helping another person.

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