End of Life Choice Bill

Thank you very much, Madam Chair. As you say, we move to the debate on Part 3 of the End of Life Choice Bill, which is entitled “Accountability”. There has been a lot of discussion on this bill about safeguards and what sorts of protection there are for people who want nothing to do with this bill or who want to ensure that, if they do take advantage of the End of Life Choice Bill, they will have their rights protected. Many of those safeguards occur at the level of the consultation between a doctor and their patient, and those safeguards were debated extensively in Part 1, where we debated in particular the definition of a person who is eligible for assisted dying, and in Part 2, where we debated the process that is required to be followed by people under the bill. Part 3 is also a part which is about safeguards, but at a macro level. It talks about some of the procedures and establishes some bodies to ensure that assisted dying is done in a safe, transparent way where people are able to see that there is oversight at a public level.

First of all, in clause 19, the bill establishes the Support and Consultation for End of Life in New Zealand (SCENZ) Group, requiring the director-general to establish Support and Consultation for End of Life in New Zealand. The role of the SCENZ Group is to keep records—lists, that is—of medical practitioners who are prepared to act as replacement medical practitioners in the case that a doctor conscientiously objects and a patient wishes to find a replacement medical practitioner. They also keep a record of psychiatrists. I note that my Supplementary Order Paper (SOP) 259 amends this from “specialist”. It cannot be a psychologist or a psychiatrist; it must now be a psychiatrist. They keep a list of those who might be called upon if one of the medical practitioners involved in the process we discussed in Part 2 decided to call on a psychiatrist to check that somebody was indeed mentally sound and a person eligible for assisted dying under this bill. They also keep a register of pharmacists, and the SCENZ Group also sets out procedures in relation to the administration of medication.

The SCENZ Group has a membership of people that the director-general considers to have, collectively, knowledge and understanding of matters relevant to the functions of the SCENZ Group. And I might take that opportunity to address some of the amendments that have been put on the Table in relation to the SCENZ Group. For example, SOP 336, in the name of Paulo Garcia, has put an amendment suggesting that the committee put in statute that the SCENZ Group should actually have to write down its procedures and release that. I don’t think that’s something that belongs in statute; I think anybody put in charge of maintaining a statutory body would write down their procedures. And, of course, we have open government in New Zealand—a range of procedures that people can use to discover them if that is truly of interest.

Agnes Loheni says that SCENZ must keep the records for seven years. That’s already covered by the Public Records Act, so would be redundant. Melissa Lee talks about conflicts of interest in SCENZ if SCENZ is considering the action or inaction of a person. First of all, it’s not clear in what circumstance SCENZ would be considering the action or inaction of a person, but a theme with many of these amendments—conflicts of interest are something that the New Zealand public sector routinely manages. It seems rather odd to suddenly start putting statutory requirements to manage conflicts of interest in a specific place.

Jo Hayes has said that the qualifications of people on SCENZ should be published. Again, the Minister already has a requirement to appoint people who have adequate knowledge to fulfil the role of SCENZ. It’s not entirely clear why it’s necessary to put in statute that those qualifications would be declared. But, again, if they didn’t declare them, there’s a range of ways that people can find out—through the Official Information Act; parliamentary questions, written and oral, they could ask; or they could even check on LinkedIn to see what sorts of qualifications the people had. It hardly seems to be something that we need to put in statute.

Melissa Lee—SOP 332 is saying that nobody on SCENZ should ever be the subject of a complaint to anybody about anything in relation to the End of Life Choice Bill. The difficulty with that amendment is that it doesn’t say what the result of the complaint should be. So any vexatious complaint would disqualify anybody from being on SCENZ. That would be an extraordinary thing for the committee to legislate.

Agnes Loheni says that there should be no conflicts of interest in SCENZ. Of course, the director-general, in appointing SCENZ, would already be required to consider that.

Paulo Garcia says that the skills of people on SCENZ should be listed in statute. Again, if he was to look at clause 19(1A) of my amendment number 259, he would see that indeed the director-general is already required to put in place people who have the requisite skills and knowledge to carry out the role of SCENZ. It’s not clear why this committee should try and second-guess the director-general in what those skills should be. There may well be omissions that the House would live to regret and so on.

Kanwaljit Singh Bakshi says that he wants to specify the number on SCENZ. Again, he should look at clause 19(1A) in my SOP 259, which has been in the public domain for several months now. It says that people have collectively the knowledge and understanding to carry out the role of SCENZ. So that implies that he will get the right number. Why this committee would decide to second-guess him in what that number is, I’m not really sure.

Simon O’Connor came up with a very interesting amendment. He suggests that, instead of saying that SCENZ should be established, it should also point out that SCENZ needs to be maintained. I don’t know how much work Simon O’Connor put into it, but if he was to look at section 103 of the Financial Advisers Act, section 150 of the Anti-Money Laundering and Countering Financing of Terrorism Act 2009, or section 56 of the New Zealand Superannuation and Retirement Income Act 2001, he would see that there are many precedents and that it’s quite normal for an Act to require somebody in the Government apparatus to establish a committee—and, yes, that implies that it be maintained. It’s also the case that it would be impossible for this Act to function without SCENZ. So, if the civil service can’t work out that not only do they need to establish but also maintain SCENZ, we are in much bigger trouble in this country than I’d hitherto realised.

Chris Penk says that he wants a lawyer to be on SCENZ. He seems, I think, to have misunderstood the role of SCENZ. The role of SCENZ is to keep lists and stipulate what medical procedures are. I don’t think that’s something that a lawyer would be required for, but, of course, it’s quite possible that the director-general will disagree with me, and if the director-general did, then they could indeed put a lawyer on SCENZ. There’s no reason they can’t do that, and who knows, it may be that Chris Penk is right, but if he is, I’m sure the director-general will agree with him. If the director-general disagrees with Chris Penk, then perhaps it’s wrong to pass this amendment.

And, finally, Chris Penk wants term limits on SCENZ and also diversity quotas. I’m actually tempted to support this simply because it would be so ironic that Chris Penk was introducing diversity quotas into the bill. However, this is a very serious matter and time limits have a problem that is characteristic. The problem with time limits is that they mean that you will never accumulate experience in an institution. Funnily enough, the state of California is a very good example of this. Because of their time limits, they often have very inexperienced politicians, and I note that Chris Penk, who put up this amendment, has been here only just on two years. He might gain a lot more experience if he was to stick around, but of course his amendment would prevent that from happening.

That takes us to clause 20. Clause 20 establishes the Review Committee. The Review Committee consists of a medical ethicist and two health practitioners—previously two medical practitioners, but under my SOP 259, two health practitioners, one of whom must be a medical practitioner, and most people would say a doctor experienced in end of life care. Making it “health practitioners” raises the possibility, for example, of a nurse practitioner. I’d like to acknowledge the New Zealand Nurses Organisation, who have been in touch about this and said, “Look, these nurse practitioners play an important role and could offer an important perspective.” So that possibility has been raised. We have put in place the possibility of a nurse practitioner being in place, for instance, by making it a health practitioner. So three people in total. It must consider reports sent to it by medical practitioners who are engaged in end of life choice.

They have to report to the registrar whether it considers that the information is adequate. So every time somebody goes through the procedures in this bill, the forms get sent through to a review committee, which informs the registrar, which we’ll get to in clause 21, as to whether or not, in their view, the doctors are doing the job right. And, of course, they can direct the registrar to follow up on any anomalies. So this is actually a fairly compact and straightforward group. They receive the reports and they advise the registrar. The easiest way to think about the review committee is that they are advisers to the registrar and their membership is a combination of medics and medical ethicists.

I should turn to some of the amendments that have been raised in relation to that. For example, we have the idea from Chris Penk, in Supplementary Order Paper 342, an amendment that there should be a person on there who has obtained relevant qualifications and experience in the disability sector. I think that’s a very worrying trend. Of course, we would hope that all appointments in New Zealand would be taking into account the needs of disabled New Zealanders, and certainly people who are involved as health care practitioners would be very conscious of the needs of people in the disability sector. I think to suggest that we need to explicitly include that would actually be the start of a worrying trend.

We’ve got Kanwal Bakshi, who has suggested that there should be somebody who is qualified in geriatric care and somebody in palliative care. There’s already a requirement of having a medical practitioner experienced in end of life care. It’s not obvious why Kanwal Bakshi wants to make that amendment or what change it would make, given the role and size of the committee. Paulo Garcia, again, seems to have reprised an earlier amendment, that I commented on, to the SCENZ Group, saying that if there’s been any kind of written complaint to any relevant professional body, regardless of what the outcome of that complaint was, the person can’t serve on the review committee. The basic natural justice implications of that are terrible. If someone complains about a person, then they’re disqualified from membership. I think that’s very much in the “Whisky Tango Foxtrot” file.

Agnes Loheni’s Supplementary Order Paper 345 has said that the Minister has to publish an up-to-date list of members of the review committee and a description. I think, you know, frankly, it would be very unusual if the Minister didn’t publish a group, and also that the Minister would have to be responsible to all of the open government procedures that we’re used to in New Zealand. And if indeed people were genuinely interested and the Minister was trying to keep it a secret, there’s no facility for a Minister to do that under New Zealand law, so I’m not entirely clear why that amendment is necessary.

We then have Supplementary Order Paper 346 from Melissa Lee—if a person has a close association with a person involved in the review committee, they must recuse themselves. I think if in the State sector it was not normal for people to do that, we would have a serious problem with conflicts of interest. Of course that is something that would be done. If we need to use statute to define how to respond to every conflict of interest in New Zealand, then we are in serious trouble.

Jo Hayes has said that the review committee must keep written records of its operations. Again, that appears to be perhaps even plagiarised off another amendment. Some people should talk to each other, because the objection, of course, is that, under the Public Records Act, that’s already a requirement. And, finally, on this particular clause, clause 20, Melissa Lee has said that, again, they must regulate their own procedures for performing functions and duties and make them publicly available. Well, of course the review committee is going to write down how it performs its functions and duties. I don’t think that’s something that this committee needs to put in statute.

There’s several more amendments here, but I suspect that I’m going to run out of the patience of the Chair if I go through every single one. So let’s move on to the registrar. The registrar is a person, an agent, within the Ministry of Health, and the registrar—[Time expired]

Thank you very much indeed. I sense a feeling of relief across the committee. It is interesting that the member has started on the theme of safeguards à la Parts 1 and 2. It’s a bold move from him, given that it’s been clearly established in the debates on Parts 1 and 2, before such time as they were shut down, that in fact it is exactly the question of safeguards that we should be considering and the flimsiness thereof that has been exposed. So, Madam Chair, I can only wonder at the member taking three calls consecutively and seeking a fourth. And I wonder if, by trying to pre-empt discussion and debate on the various Supplementary Order Papers (SOPs), he wasn’t trying to shut the debate down in the manner of proposing a closure motion on his own debate at 9.45 the last time we met for this purpose.

Perhaps just before I get on to speaking very specifically about the particular provisions of Part 3, may I appeal to those in the Chamber, including those watching, those who are in favour of the principle of euthanasia and assisted suicide and who might come to that position from a philosophical basis of choice—which is understandable, of course, as far as it goes—that before we start to consider aspects such as coercion and undue influence, and say, nevertheless, that if the provisions of Part 3, like those of Part 1 and Part 2, and—spoiler alert—Part 4 are shown to be unequal to the task that is required in order to have a safe piece of legislation, and that they take those very seriously indeed in relation to the SOPs in voting on this part and indeed, ultimately, the third and final reading of this bill.

I’d like to speak specifically, initially—another spoiler alert; I’d like to speak also not initially but continuing throughout the night—on the subject of SOP 345, in the name of my excellent colleague Agnes Loheni. Agnes proposes that, and I quote, “The Minister must publish, in a manner readily accessible to the public, an up-to-date list of the members of the Review Committee, including at minimum a brief description of the relevant qualifications and experience of each member.”

The purpose of this, it seems to me, is to provide a measure of assurance, accountability—seeing as the supposed theme of the part is a manner of accountability—whereby those who are comprising the review committee are themselves capable of at least some measure of review. We’re reviewing the reviewers by this suggestion, such that we’re not simply asking the New Zealand public, who will be interested in this matter generally, and of course more specifically those who themselves might be considering what assisted dying, as it’s called euphemistically, might mean for them and of course their loved ones. So for those who have an interest, which is potentially every single New Zealander, in the matter, for those people it’s important to know that those who will be reviewing the operation of the Act and the specific operation in so far as particular cases are concerned, those people must be known to be experienced and qualified in a manner that is appropriate.

Other SOPs deal with what those kinds of qualifications and experience might look like, and I won’t pre-empt that debate for later this evening, no doubt from other colleagues as well, except to say that if I were to revert to the classic aphorism that justice must not only be done but also must be seen to be done—so it is that in this case, regarding the review committee, we have to conclude that it’s important that we have a degree of accountability and transparency such that they will be able to do the very serious job, the significant task, that they have, which is to provide at least some measure of accountability and indeed review under the law.

The experience from overseas, Madam Chair—I suspect I won’t get much opportunity to go into in this call, but I will seek to continue that by way of another call later when others have had a chance to have a crack. But the experience of overseas, just by way of highlighting the debate to come, has been around the fact that abuses naturally have occurred and will occur. Overseas, in Belgium for example, notwithstanding that Belgium is a very different country and has, for example, obviously a different language in which the Act would be administered—none the less, they are humans there too, as we are, and, as such, human nature would apply, such that the excess of those in a position of power and responsibility must be checked, must be understood, must be reviewed.

Thank you, Madam Chair. I’m pleased to take a call on Part 3 of this bill, around accountability, to really highlight and question the sponsor of the bill about the lack of accountability around this assisted suicide bill that is so sensitive in enabling and legalising New Zealanders’ lives being terminated.

The real concern that I have is that in the parts that we have dealt with to date, there is a real reliance on the law in respect of determining whether a person is terminally unwell, on the law determining whether a person is not mentally unwell, that they’re of sound mind, and on the law in respect of the value judgment as to whether a person is inappropriately being influenced. The question that I want to put to the member in charge of the bill is really practical, and it is: if someone’s life is terminated under this law—and it could well be a spouse, a son, a daughter, a parent, who doesn’t even find out about the fact that their loved one has been euthanised, how do they, under this part, titled “Accountability”, test and find out as to what’s gone on that their loved one is now dead.

Because when I look at these clauses, all I see is barriers to families being able to find out what the heck’s gone on. We’re removing all criminal liability. People are completely exempt from the criminal law. On civil liabilities, there’s a provision that completely exempts any check in civil law. The coroner is being blocked out of the process. So the really practical, real question I want to know is: if your loved one is euthanised and you think something’s gone wrong—maybe you think a family member who was going to get a big fat inheritance inappropriately influenced the decision; maybe you think the doctor had a conflict of interest; maybe the judgment about the person being terminally unwell; or the judgment call that you’ve got evidence the person was depressed—and that should have been picked up. Where does a loved one in that circumstance go? The provisions that are under Part 3 of this bill provide me no reassurance at all.

The other part that really worries me is that when we look at the jurisdictions that have these laws, there have been horror stories of things that have gone on, people that have not wanted to have their life terminated, who have been held down and forced to take the injections; people that have been clearly mentally unwell. What we know in those other jurisdictions is that there have been negligible prosecutions. Yes, there might be some ticked boxes and some bureaucratic paperwork done, but there’s no mechanism for the level of scrutiny that we would expect as Parliament in a country that puts such a high value on life.

I look at the level of investigation that we now put in when there’s an accidental death, and the effort the coroner goes to to establish the truth of the facts. I look at the sort of checks that we now put in our workplace safety laws. I even look at how this week, ironically, the Government has just set up a new office for suicide prevention that’s going to have the powers to investigate where suicide is going to occur. And then we have Part 3 of this bill that, effectively, shuts down any proper scrutiny of this legislation.

Well, I put a question to the member: in those jurisdictions—whether it be Belgium, whether it be the Netherlands, or whether it be those jurisdictions in the United States—with the thousands and thousands of people that have had assisted suicide, in how many of those cases has there ever been a legal test properly done, and how will family members do that? This part of this bill is really a whitewash. Yes, it provides a reporting method; you’re going to be able to find out how many people have had assisted suicide. But if you’re after trying to find some accountability for a loved one that has been inappropriately provided with assisted suicide, it is weak as water and does not meet the standards that this Parliament should require.

Oh, thank you very much, Madam Chair. It’s great to take a call. I have to reflect on the irony, as we begin this Part 3 debate around accountability, that the member sponsoring this shoddy little bill—and I stress “little” because it’s really only a couple of pages, and we’re talking life and death—was very quick to not only shut down earlier debates himself but took the liberty to pre-emptively talk about Supplementary Order Papers (SOPs) which have been tabled by a number of members. I think it’s actually quite symbolic of the whole problem that I and others on this side of the Chamber, in particular, have that the member doesn’t want to have a conversation, he just wants to tell people. And, you know, that’s all well and safe in this Parliament, but you just need to extrapolate that to the bed of the sick and dying, and I would say it’s what makes me concerned: that actually there will be no discussion. Those who are sick and dying and disabled will be just told that, you know, David Seymour and his friends know best, and when there’s protest, they’ll say, “The debate is over.” We are concerned.

He spoke, when he attempted to pre-empt the SOPs—again, not willing to listen to likes of Agnes Loheni or Kanwaljit Singh Bakshi and get the context, because who cares about context? I mean, what are we talking about here tonight? That’s right, killing people! I mean, we ended up getting on to money-laundering a little bit earlier, as an example, but, you know, we’re talking about killing people. You’d think you might have a bit of accountability beyond a couple of pages.

Accountability also starts with understanding the medical profession that is being referenced in Part 3. The member who initially took the call talked a big game that now we’re having psychiatrists. Well, members who support it might think that’s OK. Well, there are only about 600 psychiatrists in New Zealand; there are over 2,000 psychologists. So things have just got a lot worse.

The member, as he discussed Part 3, talked about nurse practitioners. Isn’t this marvellous, now that we’ve widened it to be not medical practitioners—doctors—we’re now going to make it health practitioners, and it could include nurse practitioners! I’d be fascinated if the member would actually give the number; I doubt he knows it. So I’ll tell him: there are only 300 nurse practitioners. Had he turned up to the Health Committee, he would have heard that his blessed unions of nurses were supportive of the euthanasia bill because—and you can look it up—“It will save money.” They thought it was a good money-saving opportunity. If the member had turned up a bit, he would have heard more of it.

So, shocking start around accountability—accountability in its general sense; there’s no accountability to the person who’s dead. All right, for those who are supportive of euthanasia, this reporting section is there just to assuage you—or them, sorry; I don’t know the yous and the thems now. The accountability doesn’t help the dead person. This is classic bureaucracy: rubber-stamping and ticking boxes, nice pieces of paper in black and white.

Let’s, for a moment, take the thought experiment that the person was incorrectly killed. I think we call that murder. I don’t know if we’d call it that here; now we’d probably just call it an accident. But if the person’s dead and it was done wrong, all this section does is a trail of paperwork. Maybe if we look at other jurisdictions where a doctor’s done something wrong—and Nick Smith rightly pointed out people are held down, forms are not filled out, and procedures are not correctly followed—all of this Part 3, all of this accountability, will it bring the dead person back? No. No.

People shake their heads: “Oh, this is terrible.”, because we’re just talking about euthanising people here; we’re talking about people having their lives ended. I will once again note the irony of those who go around and say, “Oh, isn’t all this suicide of our young people terrible?”, but then, quite happily, will knock off another group of people.

The accountability in this Part 3 is post factum; it’s after the case. There is no accountability. There isn’t anything here. The dead person will not come back at all. It doesn’t help, and the repercussions are minor. This is classic bureaucracy.

I’d like to just touch—because, I don’t know, the calls have been ruthless of a sort—on SOP 259. Once again, I had to put this in to change clause 19, first and foremost to demonstrate shoddy drafting. I’m really shocked at the lawyers; again, we know who they are—shoddy, shoddy drafting. So it talks about opening the Support and Consultation for End of Life New Zealand Group, and it has to be appointed. I go on, and I’m trying to make a suggestion that, actually, it has to be clear in the legislation that it also needs to be maintained. I do that for two reasons: first and foremost, this is a deadly serious bill—every pun intended. We are not talking here about a small bit of tax law—

💬 David Seymour: The member’s question has been addressed.

—or a change in the speeds; we are talking—and he says, “Oh, it’s already been addressed”, because David Seymour doesn’t care what you think. Just remember that on your death bed: David Seymour and the pro-death advocates—[Time expired]

Thank you, Madam Chair. It doesn’t get any more serious than this in this House, where our role and responsibility as legislators is to talk about life and death. The arrogance of the sponsor of this bill, David Seymour, was that he tried to shut the bill down. Many in this House, on the second reading, said, “Let us do due process. Let’s ensure that it’s robust, it’s clear, and that we would have the opportunity and the time to be able to do that.” Can I remind us that McGee, in Parliamentary Practice in New Zealand, talks about this: in order for a piece of paper to turn into legislation and law, it has to have a robust process in this House. Nothing gets more serious than this.

I don’t speak to the sponsor of the bill, because the truth that is he doesn’t care. For those of you that are over there in the Chamber, I plead for you to take the time to understand and to read what the bill is actually intending to do. The bill, initially, in Parts 1 and 2, is talking about choice—in fact, that’s why it’s called the End of Life Choice Bill. But Part 3 talks about accountability. You see, the reality is that for every choice, there is a consequence. So what I want to say to those on the other side of the Chamber, and those who aren’t here—of those 120 members in this House—is to know this: our duty of care and responsibility is to legislate in such a way that we do not make mistakes. You see, mistakes have unintended consequences, and we will bear the brunt of that responsibility. Can I remind the members in the Chamber that’s the role that we were elected in to this House for.

So is there an opportunity? It was only just today in this House, during question time, when the Prime Minister stood up and said this, in regards to being accountable and in regards to suicide: “One death is one death too many.” So this Part 3 is about accountability. So the question is this: could there be a possibility that we could get one death wrong? Is there a possibility that other jurisdictions have got it wrong? I want to say to members on the other side that even the sponsor, David Seymour, admits that it has been gotten wrong in other countries, like the Netherlands and like Belgium, who’ve had this for a number of years. And even in Canada. Why? Because they got it wrong. But here’s what they do: in order to tolerate the fact of the actions to their consequences, they say, “Well, they were going to die anyway. They were going to die anyway.” I was at a debate, and I was there with Maryan Street, and we talked about accountability, as this Part 3 talks about, and I posed the question about the review in Belgium. It talked about, potentially, there may have been 10 to 12 percent. Now, she questioned that and said, “No, that’s too high.” I asked, “So what’s an acceptable level of accountability?” “Well, maybe we’ll lower it to 5 percent.” Even 5 percent of the 6,000 that were killed through being euthanised, that was one too many.

So, to the members on the other side, I ask that you take the opportunity, that you even take a debate, that you ask the questions. Do the work that you were elected to in this House. It’s not enough for others on this side here to be passionate, to be caring enough to take the time to do it; I would ask that those members on the other side do the same thing.

Clause 20(2) talks about this. The fact is that, under the review committee—but the reality is there’s no recourse for people who end their lives based on a misdiagnosis. The truth is, technically and clinically, there are misdiagnoses that happen all the time. Can I comment from Professor Roderick MacLeod, who’s probably New Zealand’s most leading palliative care specialist, and he clearly states this: “If you’re going to create a category of those who may be killed, then diagnosis has got to be right 100 percent, and prognosis has got to be accurate. But these things are very inexact sciences.” In other words, they cannot be determined. So, to the member in the chair, David Seymour, to the others that are over there: where will you set the threshold? Could we get it wrong? Answer is yes—other jurisdictions have.

Why would we allow a law like this to go through? There is no recourse. In clause 20, it clearly states this. There is no recourse for those who’ve been misdiagnosed. In other words, there’s no reporting where people have got it wrong, where doctors have got it wrong; they’ve admitted to the fact. There is plenty of research that actually clearly states this: “There has been a misdiagnosis, we have got it wrong.”

What will our whānau say? What will our family say? What will you say as legislators on the other side? Did you fight for this bill to make sure that it was safe enough? If you’re going to vote for it, then make sure it’s safe enough. Make sure that, your hand on your heart, you can say this: “We’ve ensured that this bill has all the safeguards. We’ve looked at all the jurisdictions across the seas and we’ve seen the factors; actually there’s not enough.” Yeah, that member can shake his head, but the reality is he doesn’t have enough life experience to know what the reality of life is. He can be the policy guy that turns around and gives a whole set of answers to all these Supplementary Order Papers, but the reality is he knows he’s wrong.

Before I call the next member, could I remind members that we’re debating Part 3, which is clauses 19 to 22A. A passing reference to the subtitle of the Part is not sufficient to be addressing it. So I’d really encourage all members to address the part.

Thank you, Madam Chair. Part 3 is about accountability. Accountability is about taking responsibility and accountability for one’s actions. So who is accountable? So this part, Part 3, details the four roles, the four particular groups of this section. So we’ve got the Support and Consultation for End of Life in New Zealand Group, we’ve got the registrar, the review committee, and the Health and Disability Commissioner. But in this bill none of these four parties are authorised to collate and review the information pertaining to a case. So how on earth would any of these parties be in a position to report whether the death has occurred in accordance with the Act? As I said, there is no oversight, there is no accountability in reality in this part, and I’m just going to just step through the process around what it would look like for this particular part.

Before the process of the diagnosis, or a decision to proceed with the lethal dosage, the registrar needs to receive a form from the medical practitioner involved, and when the registrar receives the notification, he’s got to have what the lethal dosage is and the date of administration. And the registrar needs to notify the attending medical practitioner if it is satisfied that the processes have been complied with under clause 15.

If the registrar is not satisfied, the bill does not require the registrar to do anything about it. Then the medical practitioner is supposed to wait with the administration of the lethal dosage until such a notification is received from the registrar. But the bill is silent on what should happen if such a notification is not received before the chosen date of the administration of the lethal dosage. We have to ask ourselves: might a doctor who believes that he has followed the correct process go ahead with the administration anyway?

And then we have after the event—after the death. In that process, the registrar needs to receive the assisted death report by the attending medical practitioner or the nurse practitioner who administered the lethal dosage. According to clause 17(3)—the registrar is not authorised to inspect this form or compare its information with the information on the other forms pertaining to that case, so if there is an anomaly, the registrar is not authorised to report it or to do anything about it—the registrar only needs to send it to the review committee. The review committee then has to review the assisted death report and, according to clause 20(2)(b), report to the registrar “whether it considers that the information contained in an attending medical practitioner report shows satisfactory compliance with the requirements of this Act;”. But they have to do so without having access to all the other forms pertaining to this case. In effect, the review committee is acting blind on other information.

The review committee will only be able to assess whether the form was filled out correctly, but they will not be able to tell whether the death occurred without coercion or whether there was informed consent. The review committee will not know whether a nurse practitioner who has administered lethal drugs was really authorised to do so. This bill does not require the nurse practitioner or the attending medical practitioner to provide evidence that the nurse practitioner was authorised to do so. There is no requirement for any witness to be present at the time the person has asked to proceed with the administration or to rescind that request at a later date. There is no need for the person to be competent at the time of confirming whether they want to go ahead with the administration. The bill is silent on what a medical practitioner or nurse needs to do if there is a doubt whether the person is competent or if the person isn’t able to communicate their wish at that time.

Thank you, Madam Chair. I rise to speak in Part 3, as I have in Part 2 and Part 1. I was the deputy chair of the Justice Committee and we undertook through that process to hear all of the people that asked to be heard before our committee. We did our level best to do that and it took a lot of time, but it was worth it because people’s lives are at stake. This is the most serious piece of legislation, and, of course, it is one of the most poorly drafted and poorly crafted pieces of legislation that many of us have ever seen—certainly in my case. I feel it has been ushered through this House with unseemly haste.

Every single provision to try and make this bill safer—for those of us who have grave reservations about this bill, we have put in a lot of effort, along with hospices, along with many of the people who made submissions on the bill, to try and reflect their concerns—and they’re very real concerns—about the lack of protections for the vulnerable. So Alzheimer’s New Zealand, Hospice—we have worked closely with them. All of these amendments have been voted down, so all of our efforts to try and make this a safer bill have not been acknowledged, and I would urge members opposite and people who are in favour of this bill to listen carefully to what we are saying about the various parts.

Part 3, the one we are debating tonight, means, ultimately, that nobody accepts responsibility. And it’s all about accountability; accepting responsibility for what we do in this House about enabling assisted suicide and euthanasia is a very important part of our role. In my case, I think it is the most important piece of legislation I’ve ever had anything to do with and I deeply regret the cavalier attitude of the sponsor of this bill and his dismissive, arrogant way of addressing the Supplementary Order Papers (SOPs) that have been done in good heart and in good faith throughout this process, and in particular with this one in Part 3.

So when we look at possession, when we look at the protections and the accountability for people who will be providing protections, scrutinising them through registrars, through the various processes that have been outlined in this bill, the review committee. We will look through clauses 19 to 21 in some detail, but I would ask members of Parliament to think about how you take responsibility for people who have been coerced, how you take responsibility and ensure that there is accountability through the registrar and through a very, very flimsy and shoddy process to ensure that elder abuse and the ability to diagnose dementia by one doctor’s meeting of an individual—and the second meeting can be done through social networking, on Messenger. That was at the insistence of the sponsor, and I would ask him to justify why he made that such an important part of the select committee deliberations. It’s all in an effort to get this through faster and to have less accountability and less responsibility, ultimately.

Freedom of choice is all very well up to a point, but if you are disabled, depressed, or have dementia, your freedom of choice is very compromised. This bill, and the provisions in particular around the review committee and the way that the Support and Consultation for End of Life In New Zealand Group is put together, the oversight of Ministers, which I have some SOPs on, which I will speak to later in this debate—as long as it’s not shut down, of course—these are the individual aspects of this bill that really do need to be drilled into. We did always intend at the Justice Committee that when this bill came back to the House, it would be talked about in detail. I don’t know that Damien O’Connor, that chairman Raymond Huo, that Duncan Webb, that other members on this committee have even taken any calls—except, of course, closure calls. That’s all they’re interested in doing. They thundered that it was important to get this bill right. This is their opportunity to stand and take a call and debate with some intellectual rigour and some emotional engagement on this issue.

When we look at the various aspects of the review committee, there is no recourse for people who end their lives based on misdiagnosis. Why is that? Because they’re dead. They’re also not necessarily able to articulate their own issues in the lead-in to seeking to find out more about death. When it comes to the review committee, it is likely that some of these cases will not ever be reported. Where’s the transparency in that? Why are they not able to be published? And SOPs that we will deal with in more detail later in the night will suggest ways in which the public of New Zealand, in which the relatives of those who have been claimed, will be able to understand what went on in the lead-up to their loved one’s death, because, at the moment, there is no transparency afforded for in this bill, and euthanasia and assisted suicide—[Time expired]

I was a little bit hesitant, because I was hoping that the Hon Maggie Barry might be able to continue, but I would like to pick up where she’s left off in speaking on Part 3. In doing so, I would just like to mention that after the debate was shut down—prematurely, I think—on Part 2 three weeks ago, I received a lovely email which was sent on behalf of the chief executive and the board chair of Hospice New Zealand, Mary Schumacher and Richard Thurlow, and I hoped that I could just put on record some of their comments, because they and members of their organisation around the country are watching this debate on Part 3 tonight. I can only assume that there would be thousands of people watching the debate who have a strong interest in it. They made the point that while a number of speakers have been imploring the member in charge of the bill to respond to the concerns that they have—and theirs are quite unique concerns. I would like to think that every member of this House appreciates the huge importance and the compassion of the work done by hospices around the country.

Now, I’m not one who is looking to string out this debate unnecessarily. I accept the fact—

💬 David Seymour: Who is? Name them.

—that the member in charge of the bill has the numbers, and yet he interjects while I speak on behalf of an organisation whose members will be required, whether they like it or not, to do what he is legislating for. I ask him to show them the courtesy that is required in order for their concerns to be heard.

💬 David Seymour: Which section is the member debating?

I’m talking about Part 3, but I’m asking the member to respond to the concerns that I think have been emailed to all members, certainly to a large number of us, by not only the national organisation of Hospice New Zealand but there was Dr Arthur Morris, who is the chairman of Mercy Hospital, and probably some other hospices as well. As they have looked at the provisions of Part 3 of this bill, they have raised with us further concerns.

Now, one of the main concerns, of course, was over the right for conscientious objection, but that’s now been taken away from them. So, as we look at Part 3, we have to look at what the implication is now. They’ve made the point, and I hope, Madam Chair, that you’ll allow me to put their words on the record. Once again, Hospice New Zealand, in the email that they have sent to us as members of this Parliament charged with making one of the most important decisions that will come before this House in our lifetime, urge MPs to consider the gravity of the subject we are debating and, ultimately, deciding upon, because Hospice New Zealand members and staff members say that they are feeling very marginalised in this discussion. With the narrowing of the criteria to people specifically with terminal illness, they are the most affected party in the provision of end of life care, but they feel that they have had very little opportunity to be involved in this discussion. Certainly they had opportunities to make submissions, but during the course of the debate in this House, they feel they have been totally shut out.

So, as the Hon Alfred Ngaro did when he spoke on Part 3 a short time ago, I urge the bill’s supporters—not just the member in charge of the bill but all of the bill’s supporters—to stand tonight and take a call and answer directly the concerns of Hospice New Zealand and their members to show that they have an understanding of the extraordinarily difficult position that this bill and Part 3 puts the hospices and their wonderful staff in.

Now, in the time available, let’s look at Louisa Wall’s Supplementary Order Paper (SOP), because that involves an application to the Family Court. I have great respect for Louisa Wall. She knows that I believe she’s a very thoughtful and principled member, and so I acknowledge the fact that I genuinely believe that she’s doing her best to make this bill the best that it can be. But the concern that has been put on is that this will now require a reference to a Family Court. Now, Hospice New Zealand are saying that if the intention is to relieve the pressure on doctors, they will still be required to undertake the euthanasia of the patient but now this puts an extra burden on them to participate in another formal process around that request. So we do need to think carefully about whether that’s a reasonable demand to put upon them, particularly as they are medical people; they’re not legal people. So, should we pass that SOP, clearly it is something of concern to Hospice New Zealand. Let’s just point out that they’re a national organisation providing palliative care for more than 19,000 people per year. Their concerns must be heard.

Thank you very much, Madam Chair. I wish to continue my fine examination—and I mean “fine” in the sense of fine-tooth comb; I wouldn’t want to suggest any fineness of the other kind—in relation to Supplementary Order Paper (SOP) 345 in the name of Agnes Loheni. Just by way of review, quickly, this is the proposal that “The Minister must publish, in a manner readily accessible to the public, an up-to-date list of the members of the Review Committee,”.

As I foreshadowed, I would like to talk about the experience overseas, in jurisdictions that have now experience in the area of euthanasia and/or assisted suicide, such as is being proposed to be legislated in this bill. I refer particularly, in the present case, to Belgium, where euthanasia is both normalised and normative. It’s worth noting that in Belgium, as in other places, of course, the nature of self-reporting in relation to practices where a person’s life is ended—that there’s an element of self-incrimination, at least potentially, where a medical practitioner has carried out the act. The essential dilemma is that if a person has done what she is meant to have done, then there is no problem, but if she has done something that she is not meant to have, then with the death report, so-called, she is supposed to dob herself in.

There’s a very clear legal principle, going back many centuries, against self-incrimination—that a person has the right not to self-incriminate—so the dismissiveness of David Seymour in relation to my SOP regarding the desirability of the presence of a lawyer on the panel seems to be, as is often the case, somewhat shallow and misjudged.

CHAIRPERSON (Hon Ruth Dyson): I’m sorry to interrupt the member, but the time has come for the dinner adjournment. The committee will resume at 7.30, when I hope we might debate Part 3.

Sitting suspended from 6 p.m. to 7.30 p.m.

CHAIRPERSON (Hon Ruth Dyson): Members, the House is in committee for further consideration of the End of Life Choice Bill. When we rose for the dinner break, we were considering Part 3. Chris Penk had the call and has three minutes and 10 seconds remaining, should he wish to take it.

Thank you, Madam Chair. I do indeed wish to resume my call, and I thank you for that opportunity.

Before the dinner break, we were talking, of course, about Part 3, and I was deep in SOP 345, in the name of Agnes Loheni. Just by way, quickly, of review, that was the proposed requirement that the Minister publish—or arrange to be published, I suppose—an up-to-date list of the members of the review committee and at least a brief description of their qualifications and experience. Where I’d got to before the dinner break was discussing the point around self-incrimination by medical practitioners, and in the context of the proposal that the members of the review committee be known to the public and that we simply shouldn’t trust that they are able to do their job, but have that measure of transparency, as we should expect in all statutory bodies, not least of all one with such serious function as this is proposed to have.

The context in terms of overseas experience is interesting, whereby recently, in the Netherlands Times, we have a report of a Dutch doctor under investigation, warning colleagues about the judiciary and saying—and I quote—“Be careful what you provide in reports. In your honesty and sincerity you give everything you have. In a criminal case, that is immediately ‘evidence’.”, and I can tell you for free, Madam Chair and anyone else, that’s pretty good advice. The least said, the soonest one is able to avoid accountability for the things that one might have done.

In the context of review—and particularly if we’re going to look overseas at the experience of jurisdictions that have euthanasia and/or assisted suicide—it’s worth noting that in the Netherlands, there is a huge gap, some 20 percent or so, between the number of reported and unreported euthanasia cases. Now, you might be wondering how we would know about unreported cases. By their definition, it is hard to know of such things, and that, of course, is half the point of the difficulty of the so-called accountability provisions, but the difference can be accounted for by the self-reported and anonymous surveys statistics versus those that have been reported and acknowledged and sent through in some detail to their equivalent of the review committee. So that’s the significant difference, even leaving aside the possibility or, indeed, certainty that there will have been some cases that lie outside even the self-reporting on an anonymous basis.

So these lessons from overseas should give us pause for thought and, at the very least, we should acknowledge them by way of a strengthened provision around accountability, such as has been suggested in SOP 345, so that we can at least know the calibre and the qualifications of those who are to be carrying out such important review work for the benefit and safety of all our citizens.

Tēnā koe Te Heamana o te komiti. Tēnā koutou katoa. Kia mihi mō te karanga i runga i tēnei wāhanga tino pai o te whiringa ora.

[Thank you, Madam Chairperson. Thank you all. Thank for the call on this very good part of the End of Life Choice Bill.]

Essentially, I want to acknowledge how incredibly important this kaupapa is, and I want to acknowledge all the emotion in the committee tonight, because we are discussing a very important topic. Ending someone’s life when they choose to, when they find themselves in a situation where they have a terminal illness, means we do have to respect this process, and I’m standing up because I do respect this process. I respect all the people that have chosen to make submissions tonight via our Supplementary Order Paper (SOP) process, and I particularly will address two SOPs.

But before I do that, I thought it was incredibly important to talk about the SCENZ Group—the Support and Consultation for End of Life in New Zealand Group—because, essentially, it is this group that ensures the accountability of the system, and that’s why Part 3 is entitled “Accountability”. I just want to walk us through the process because I think that in understanding the process, we will then understand how important this SCENZ group is.

Essentially, the proposition of this bill is that if you’re a terminally ill person and you wish to exercise end of life choice, in the first instance, you must initiate that process with your medical practitioner. So you choose that—you choose to have that dialogue; you choose to have that discussion—and what we want to see within that process is that medical practitioner then talking through all the options with the person who has a terminal illness, which also includes options for end of life care and any other matters such as asking “Is there anyone else you would like involved in this process?”—like your family.

After that has been ascertained, then, essentially, through that informed consent process, their medical practitioner then needs to seek an independent medical practitioner. That person has to go through the same process. They have to kōrero with the person, they have to ensure that they understand all the options that are available to them and if they actually qualify for end of life choice. Again, if there is any issue about whether informed consent exists, they then need a third opinion, and it is the third opinion of an independent specialist that the SCENZ Group then have to provide, so that we provide accountability in the system. That’s why this part is so incredibly important.

So this independent medical practitioner—where are they supposed to come from? Well, I just want to outline clause 19(2)(b) on David Seymour’s Supplementary Order Paper 259. This SCENZ Group ensures that—and I quote—“the attending medical practitioner does not choose the replacement medical practitioner or independent medical practitioner:”, so what we’re ensuring is a separation from that person’s medical practitioner and the subsequent medical practitioners involved in the process. There is no coercion. There is no collusion. Actually, we have an independent group, and this group will comprise those medical practitioners—and this is where it gets really interesting—who are willing to be involved in the end of life choice process.

So I do want to acknowledge SOP 212 in the name of Chris Penk because I actually hope that what he’s outlined will comprise the SCENZ Group, and they are a mixture of medical practitioners who are gender-diverse, they will ensure that those medical practitioners are culturally diverse, they will ensure that those medical practitioners are ethnically diverse, and they will also ensure that they don’t have a fixed view about end of life choice—that isn’t their role. Their role is to ascertain whether the person who seeks end of life choice can give informed consent and has been given all the information they need to therefore qualify for end of life choice support. Within that assumption they would, therefore, have to understand the palliative care options, because that is critical for that third practitioner—that independent practitioner—to give effect, which is essentially why this Part 3 is about an accountability in the system.

I also want to highlight Supplementary Order Paper 330 in the name of Mr Paulo Garcia—

💬 Hon Members: “Pau-lo”.

Paulo—apologies. I didn’t mean to mispronounce your name. What you’ve highlighted in your SOP is that the people that end up being part of the SCENZ Group have to have some medical ethical qualification, they have to have some relevance in terms of their knowledge of the disability sector, and geriatric care needs to be an area that they have expertise in, as well as palliative care. One of the other aspects you’ve highlighted is this barrister and solicitor of not more than seven years aspect. I know Chris Penk, particularly, has talked about the overlapping interests between the health and the justice systems, and he’s referenced other jurisdictions where that is more formally acknowledged.

So I want to acknowledge that the Supplementary Order Papers that have been presented tonight are valid and they are good Supplementary Order Papers, but they are also constrained by the willingness of those specialists to put themselves forward to be part of this process, which is why I hope everyone we’ve talked about—gender diversity, ethnic diversity, cultural diversity, having knowledge of the disability sector, the palliative care sector. I want all of those sectors involved, but, obviously, we’re needing people to put themselves forward to therefore qualify to be on a list to be these independent practitioners. What I will say about that process is that the director-general (D-G) therefore needs to encourage and support people from those communities to specifically put themselves forward.

That’s what the contribution of these SOPs, for me, in the House tonight will ensure, because we’re discussing and talking about how the ministry and how the people who are going to be formally involved in putting the SCENZ Group together and the register are going to engage with those specific communities to ensure that if there are members of those communities who do want end of life choice options, then we have the clinicians who are culturally, ethnically, and—I’m going to say it—religiously competent enough to engage in a manner where they can determine that, yes, informed consent exists for this person and we are happy, therefore, to say, in our opinions, they know what they’re asking for, and our part in the process is just to determine that there is no coercion and people are exercising free will and we are going to assist them in that end of life choice option because it’s something that they want to do.

The only other thing I wanted to do—and I know David Seymour outlined and addressed quite a lot of the SOPs, and I have looked at them. I have looked at the limit of two years and only two terms, membership based on diversity, that the D-G should appoint in consultation with the Solicitor-General, that the numbers should be between seven and 13. I mean, there’s a whole range, I guess, of the contributions that I have read, and I guess the reason I’m listing them all was just to say I did read SOPs 212, 327, 329, 330, 331, 332, 333, 334, 335, and 336. I’m really just focusing on clause 19, because how I looked at this was I looked at all the SOPs related to clause 19, all of those related to clause 20, all of those related to clause 21, but I thought it was really important in making my contribution that we understand where this part fits in the whole system of the End of Life Choice Bill.

That’s the reality of the discussion tonight. We’re talking specifically about Part 3 of the End of Life Choice Bill, which assumes that it is an option for people who have a terminal illness who are over the age of 18, who have asked—they haven’t been coerced to ask, but they have asked their medical practitioner for the ability to exercise their rights to end of life choice. I just wanted to highlight that this SCENZ Group and the composition of that group and their role in that process as independent specialists is incredibly important. I also wanted to bring us back to what this is all about, which for me is about giving people who have a terminal illness who can’t control whether they’re going to live or die—they’re going to die, but empowering them to die in a manner that they choose. Kia ora.

Thank you, Madam Chair. The issue that I have with what the last member said just before she resumed her seat, Louisa Wall, is that the confines of this bill will not stay confined. A group of us tonight listened to Professor Theo Boer, who talked about the situation in Holland, which has changed quite dramatically: 18 changes have occurred before it ever needed to be brought back to the House. There are now protocols for euthanising newborns. The consequences of passing a piece of legislation of this kind, that is so poorly crafted with so few protections and provisions to protect the vulnerable in it, is that it will expand immediately and irrevocably, and there is no going back. That is something that Professor Boer has talked about.

So the issues that are in Part 3 are very important ones, because who decides, normally, in Parliament what happens? Ultimately, it’s a ministerial responsibility. A Minister has to be accountable. I don’t think that a life-and-death situation—which is why I put this Supplementary Order Paper (SOP) together looking at the involvement of a Minister—can be put to a public servant or an administrator to take responsibility for. So when we look at a Part 3 that has accountability and responsibility at its core, I see, as a member of Parliament for the past eight years, that the best way to ensure proper accountability and that things don’t go badly awry is to involve a Minister.

We have heard Professor Boer say that in Holland, they’ve put in motion something that they now discovered—and I’m quoting here—“has far more consequences than we ever imagined.”, because the supply of euthanasia stirs the demand, and for an increasing amount of people, euthanasia becomes the default way to die. So the culture of despair is something that a Minister of the Crown would be very aware of and have a political antenna over as well. So it is another layer of responsibility which I think is very important. As the disabilities commissioner Paula Tesoriero has said, this is a bill that undermines the position of the disabled and the vulnerable. It devalues their lives and poses significant risks. The so-called right to die for some would all too easily become a duty to die for others.

In my Supplementary Order Paper 357, I would like to alter clause 21(5) to insert “any matter on which the Minister directs them to report from time to time:”. So the Minister can come in at any time they like and make a decision based on informed material. The register, which doesn’t properly list at this stage—and there are SOPs from colleagues that will try and make that safer, and I really do hope the members opposite, who thundered during the select committee process—Greg O’Connor—might pay attention to this and see that even that member has a contribution to make to making this a safer bill.

When we look at the things that need to be available for a Minister to decide what needs to change, if things are going wrong, if there is a maverick physician who’s doing bad things, then at a ministerial level it can be arrested. So a Minister has the power to direct the reporting they wish at their discretion. These are the kinds of things that are day-to-day bread and butter for any Minister holding a portfolio, but in this case there is no proper oversight, and I think that that combined with the lack of data and the woeful situation and complete absence of safeguards in ensuring that the data that is gathered and put on this register is at an appropriate level is really something that needs ministerial oversight, but we also need to ensure that a review committee collects information that is going to be relevant to that Minister to make the right kinds of decisions.

So, again, when we’re looking at something that is so important, we have to be very careful, because doctors in Holland, apparently, and in places like Canada as well—which are really the two jurisdictions that we should focus on because they are the ones on which this flimsy bill is based. But in terms of the way that the doctors behave, the self-reporting is a problem. Just say you’re in a car, you’re hurtling at 100 kilometres an hour in a 60-kilometre-an-hour area, and you go through a red light. You’ve broken the law. Are you going to write to the Ministry of Transport and say, “At 5.35, I broke the law.”? No, you’re not, and the doctors in Holland are not doing that either.

To me, one of the issues under the register is how to gather the material and stop doctors doing, I suppose, an exercise to protect themselves as opposed to protecting their patients. We understand that about 7,000 or 8,000 people were euthanised in Holland last year, and now we see—[Time expired]

Tēnā koe, Madam Chair. It’s actually the first time I’ve spoken when you’re in the Chair, so I’d like to take this opportunity to congratulate you on your leadership. I have diligently watched you since you’ve taken the role as Assistant Chair, and I actually am enjoying your leadership, Madam Chair.

Right—

CHAIRPERSON (Hon Ruth Dyson): That doesn’t give you any longer than five minutes, but thank you.

OK, yeah—or a second call would do. Anyway, I just want to acknowledge the member that just sat down, Maggie Barry. Dr Shane Reti and I co-hosted an international conversation with Dr Theo Boer just over dinner, and I said a joke about the member across the floor. I said a Māori whakataukī that really, to me, represents that, which is—as it’s Māori language week, I tried to look for a whakataukī that actually kills somebody, but I couldn’t come up with it. So my favourite whakataukī is: “kaua e mate wheke mate ururoa”—don’t die like an octopus, die like a hammerhead shark. I want to acknowledge the member the Hon Maggie Barry for her leadership in this. If I was to need a defender, I’d want her to be my defender in terms of her diligence.

We had the Tongan Language Week last week and the theme for the Tongan Language Week was: Fakakoloa ’o Aotearoa ’aki ’a e Tauhi Fonua, which is the Tongan Perspective of Enriching Aotearoa. Our Tongan perspective is that we live a life with other people; that we live a life in a collective. It’s ironic that we are now talking about a part about accountability. We are now talking about how should we set up groups of people who will make sure of what the bill proposes to do.

So an individual chooses to exercise this option. There’s actually no Tongan word for “euthanasia”, but the Tongan word for you taking your own life is to’o ‘eku mo’ui—take my life; teu to’o ‘eku mo’ui—I will take my life. So when I put that into a Tongan collective perspective what, basically, it’s saying is take my life. But, you know, at the end, if one of my family members decides to take this option, I might have to say to them, “Wait until recess because I might not get leave to come to your tangi.”, or, because—the reason why I say that about my family is because when somebody is in pain in my family, I’m usually the one that gets called to come to the hospital to make that final decision. Why? Since I was 14 I’ve been doing this, basically, just because they think my English is better than theirs and I will understand it better.

I want to speak on Supplementary Order Paper (SOP) 341 by Simon O’Connor. The SOP talks about clause 20(1), inserting new paragraph (aa): “a person who is legally qualified by virtue of having held a practising certificate as a barrister or as a barrister and solicitor for at least 7 years;”. The reason why I’ve said that is, in the dinner break, when we heard Dr Theo Boer talk about—somebody had asked him: do you think a solicitor should be in this group? Do you think a lawyer should be in this group? He said, “Yes”. The reason why he said yes was that lawyers seem to keep in mind earlier rulings. That’s something that they do. They keep in mind earlier rulings and they actually—well, it’s their job to know the processes. If someone has been practising as a lawyer for seven years, then I would trust that person to make sure that—their due diligence in being part of this group is that they ask the right questions and that they recall the right memory.

I go back to my experiences in terms of being a 14-year-old and being part of my family and making decisions about turning off a machine that keeps someone in my family’s life open. I have been in black since October of last year, in my mourning gears, because my mother’s youngest brother has passed away. And, yes, I was the one that made the decision to talk with him about removing his oxygen mask so that he could die peacefully. So I have experience. OK, I’m 50 now, and I have experienced people losing their life with dignity.

I tell you what: the gift of that person for all of us to be in the room when they pass away—it’s their gift to us to mourn in a way that we’ll be able to live our life positively. It is the gift that they’ve given to us. So in a Tongan perspective, being in a room of a family member that passes away, that is a gift to the living.

I don’t often agree with Dr Nick Smith but I actually agree with what he said today. Some of what this bill is aiming to do is putting barriers for families to be involved in the last breath of a loved one.

Thank you, Madam Chair. Can I acknowledge, actually, the last two speakers, particularly from the other side—Anahila and also Louisa—for their contributions. I think it’s appreciated. I will, though, take umbrage with Maggie Barry; I think she may have misled the House. I don’t know anyone who can travel at 100 kilometres—or even 60 kilometres—in Auckland.

💬 Hon Maggie Barry: Not in Tāmaki.

Not in Tāmaki, that’s right. Look, in Part 3: Accountability—I was earlier touching on Supplementary Order Paper (SOP) 259, which was talking about the Support and Consultation for End of Life in New Zealand (SCENZ) Group, making sure that it’s maintained. As I say, the drafting currently is shoddy. I know that the supporter of this bill said, “Oh well, there’s a whole lot of legal precedents out of money-laundering Acts, superannuation, and the like”. I think we just need to draw the House’s attention to the fact this is a life and death bill; primarily, effectively, aiding and abetting suicide. We’re not talking about money-laundering or superannuation. Seeing it’s such a serious bill, actually taking this SOP and making the change to clause 19 to state that the maintenance of the SCENZ Group is an important aspect is not something too difficult to ask.

But touching, too, on clause 19—it’s more of a question; I doubt it can be answered. It does touch on the conscience rights, but it directs, of course, in clause 19, that the Director-General of Health must establish this SCENZ Group—I’m always fascinated that we continue to use acronyms—but, also, in clause 21: “The director-general must nominate an employee of the Ministry as the Registrar”. For both cases—in clause 21 and clause 19—where does the conscience right for that person come in? It’s a hypothetical, but, again, if you’re dealing with life and death you try to cross every “t” and dot every “i”. If we have, in the case of the Director-General of Health, who, for whatever reason, has an objection to the practice of suicide, euthanasia, how does that operate there? Maybe there needs to be some protocols put, perhaps, as an extension into Part 3 to take that on. It’s not unusual—the more someone’s trained in medicine, the more they are against assisted suicide and euthanasia. That’s absolutely evident from the evidence that comes through select committees and the like. The more you’re medically trained and the more you understand medicine, the less likely you are to support it. So the Director-General of Health, what happens if they don’t wish to be the person to establish the group? Is this law going to force them—with the added irony, of course, that choice is always put forward as the reason here, although those who advocate choice are often more than happy to take it away from people if it doesn’t suit them.

Another SOP—it’s a little self-indulgent, it’s another one of mine. It’s SOP 339; it’s a proposed amendment to say that this review committee—and, again, I just point out to the House that the review, the accountability, does nothing for the dead person. It does a lot for those who create paperwork and font types. But what the suggested amendment to clause 20 through SOP 339 is seeking to do is to say that the review committee must have a time limit of two years. Again, the current structure of the bill as written doesn’t actually have a time limit. So, strictly speaking, someone could be there for a long, long time. We heard, from Anahila, a part of the counterargument, which is you want some people with, sort of, institutional memory, but I certainly think there is benefit to have a limitation of two years and a maximum of two terms of two years; so a total of four years. I think it’s really unhealthy that a particular individual can stay on without a time limit, and I think that the fact that there are no—well, again, there’s nothing in the legislation. I do note it’s in the explanatory note but for the sake of the House and those who haven’t read it, the legislation is very specific that the review committee—there’s nothing to talk about how they can be removed because of unsuitable conduct or ill health or diminished capacity. So if there are no mechanisms—again, a woeful oversight—then one of the simple ways through is to ensure that those put onto this review committee can only serve two terms. So I think SOP 339 has some merit.

I would like to touch, also, on another amendment on clause 20. This is through SOP 340. This SOP is not in my name, which may perk up some people’s interest for a moment. This is in the name of Chris Penk, and it’s a proposed amendment to SOP 259. The earlier one that I touched on is a direct SOP change to the bill as it stands; this is an attempt—[Time expired]

Tēnā koe, Madam Chair. Tēnā koutou katoa. I stand to speak to two Supplementary Order Papers (SOPs), both of which are in my name, seeking to amend clause 19 to add detail and criteria to clause 19 to make the Support and Consultation for End of Life Choice in New Zealand (SCENZ) Group more substantially supported in the role that they have to perform—particularly, especially, as provided by clause 19(2)(g) of SOP 259 in relation to the administration of a lethal dose of medication to someone who has decided and has sought assisted dying. Specifically, the SCENZ Group is tasked to prepare the standards of care to advise on the required medical and legal procedures and to provide practical assistance if assistance is requested.

Quite clearly, the SCENZ Group members will be holding a very heavy responsibility in performing their role, and so SOP 330 seeks to prescribe specific skills and background experience for the members of the SCENZ Group that the director-general will be given so that he can choose well. At the same time, SOP 336 prescribes for a regulation of its procedures in the performance of its functions and duties and responsibilities; its procedure for handling any complaints about its actions, processes, or procedures; and making its procedures publicly available in the manner that it considers appropriate. So in both SOPs—SOPs 330 and 336—the aim is really to just be able to provide a meaningful guideline to what the SCENZ Group is comprised of, particularly in the skills that are needed in the carrying out of the role that they are given.

So, currently, SOP 259 does not prescribe any specific skills for the SCENZ Group members, just that the director-general must appoint members that the director-general considers have, collectively, knowledge and understanding of matters relevant to their functions. Considering the critical role that the SCENZ Group is given by the bill, providing for no specific skills and specialist experience and prescribing only general collective knowledge and understanding reveals the lack of importance and concern for what that crucial role is that they must undertake.

SOP 330 seeks to provide for specific skills: firstly, relevant skills and experience in the field of medical ethics; secondly, relevant skills and experience in the disability sector; thirdly, a medical practitioner whose practice specialises in the area of geriatric care; fourthly, a medical practitioner whose practice specialises in the area of palliative care; and, fifth, a person who is legally qualified by virtue of having held a practising certificate for some time these seven years.

The proposed specialist skills and experience deal directly with the ability of each SCENZ Group member to effectively perform their prescribed roles, and SOP 336 then provides it with the ability to regulate its own functions and carry on with whatever matters may arise from the discharge of their functions. Thank you, Madam Chair.

Before I call the next contributor, could I really encourage people to take the lead from the newest member of the House and speak to relevant Part 3 or Supplementary Order Papers.

Thank you very much, Madam Chair. I do intend to stick strictly to Part 3 and accountability as mentioned in the bill. I would like to, from the very outset, voice in this committee and state publicly, because this is the first time I have spoken to this bill, that I do not support the End of Life Choice Bill.

I believe that it has not protected the most vulnerable, and, to that point, I would like to speak to Supplementary Order Paper (SOP) 73, in the name of Kanwaljit Singh Bakshi, which seeks to amend David Seymour’s SOP 259. The reason for that is because the number of members of the SCENZ Group does need to be specified. It needs to have a range. In this SOP, it is suggesting a range no fewer than seven and no more than 13.

We have heard tonight from several contributors about the contribution that Dr Theo Boer made in the absolute essential condition of getting this group, the SCENZ Group—I’m just trying to find it. It took me quite a long time to find out what SCENZ meant, but it actually is Support and Consultation for End of Life in New Zealand. How absolutely essential it is to have that oversight completely locked in, because that is the only oversight that there is for the doctors performing these procedures. SOP 73 seeks to amend—

💬 Hon Tim Macindoe: It’s 329.

Oh, sorry—it was SOP 329.

💬 Hon Tim Macindoe: That’s the one you’re talking about. You’re on the right one; it’s just a different number.

Oh, OK. Excuse me, Madam Chair. I just got a bit distracted.

So this SOP would then read “the number of members that the director-general considers appropriate, but in any case no fewer than 7 and no more than 13”. As my colleague Paulo Garcia has just mentioned, the skill set that is required on that oversight committee, the SCENZ Group, is essential in ensuring that these procedures are carried out in accordance with the bill.

We heard tonight, from Dr Boer, that it is essential for that group also to have access to the complete patient file. He was really adamant about that when questioned in detail, because, himself being a doctor and being on one of those SCENZ groups, it gave him the opportunity to read the entire file. He spent two to three hours per file examining it prior to going into the review process, and it was interesting to look at the statistics around the difference it made in having a very rigid process with oversight from a range of experts and having access to those patient files. The quote he gave us was that there are about 10 cases a year that are found to be not compliant with the bill in the Netherlands; where he compared with Belgium, where they do not have the same access to patient files by the same kind of oversight group, there had been one case in 20 years that had failed to meet the criteria. So I think it’s really, really important that if we are to go down this path, we do have absolute certainty in the make-up, the professionalism, and the access to information of this Support and Consultation for End of Life in New Zealand Group.

The other issue that I would just like to raise very briefly is a concern about the people that are actually undertaking these procedures—the doctors that are involved—and what kind of pastoral care, ongoing psychological long-term tracking, will be done in terms of them having to perform these procedures. I do have concern for them as individuals being involved in this, and so my question to—[Time expired]

I move, That the question be now put.

Thank you, Madam Chair. Te Heamana o te komiti kia mihi mō te karanga. He kaupapa tino nui tēnei.

[Madam Chairperson, thank you for call. This is an important matter.]

In relation to this being Māori Language Week, I took some advice from my very good friend from across over there. I texted her and said, “Give me some Māori kōrero for me to actually say.” So thank you very much, Louisa Wall, for that assistance.

Madam Chair, thank you for giving me an opportunity to rise. This is the first time today that I’m actually speaking, and I look forward to potentially getting another call later on to speak to some of my other Supplementary Order Papers (SOPs), but right now I’d like to talk to two: one is Supplementary Order Paper 332 and the other one is SOP 334. Both are in relation to the SCENZ Group that earlier members have actually spoken about. I’ll start with SOP 332. This is to amend clause 19, after clause 19(3), to insert subclause (4) that “No person may be appointed as a member, or remain as a member, of the SCENZ Group if they have been the subject of a written complaint to any relevant professional body (including, for the avoidance of doubt, the Health and Disability Commissioner) in relation to any thing done or failed to have been done in accordance with, or nominally in accordance with, this Act.”

I think—in light of what’s actually happened in many different organisations, and particularly so in this bill, when we’re dealing with life and death situations—the people who are actually looking at reviewing, looking at the particular issues in place, I think there needs to be more transparency, if ever, that the people who are representing the families, the people who are actually putting our legislation in closer scrutiny, they must be beyond reproach. I believe that any complaint that they’ve ever received, they’ve got to be beyond that.

I think, earlier, Louisa Wall actually supported the very idea that people who have different, diverse groups—whether they be ethnicity or religious or cultural, I think we do agree. But in this particular case, if they have been subject to a complaint, if they have in fact had issues with trust, and perhaps misconduct, I believe they should be removed from this particular grouping, in my opinion. So that is what this Supplementary Order Paper 332 actually gets to. As we said, it is actually the conduct of the particular member that is in question. I think we need to put extra added protection for our vulnerable communities.

The other in relation to the SCENZ Group is the Supplementary Order Paper in my name—both in my name, actually. This one, SOP 334, is actually in relation—it’s very close, very similar. This is actually about “A member of the SCENZ Group who becomes aware that they have a close association (whether financial, personal, or professional) with a person whose actions or inactions are being considered by this SCENZ Group in accordance with its functions detailed in subsection (2) must recuse themselves from such consideration.” I believe the word “must” actually goes there. I think if there is actually an issue of conflict of interest—I mean we try and manage this in this Parliament. We expect people who work in the public office to actually manage these issues very, very carefully and transparently. I think, when we’re talking about people who will consider other people’s lives in their decision-making process, they must have the transparency. If there is, in fact, any kind of conflict of interest, they must recuse themselves from that particular group.

Obviously, there’ll be more that I would actually like to talk about in these SOPs that I’m actually proposing, and I hope that other members will actually consider my SOPs 332 and 334, because I believe that these actually give added protection should we actually end up voting for this bill. To put it on the record, I stand firmly against this very bill.

I call Alfred Ngaro.

Thank you, Madam Chair. I take your point before the dinner break about speaking to the parts of the bill. So, in Part 3, I’d like to particularly talk to clause 20 in regards to the review committee, and I will speak in particular to that.

The sponsor of the bill has talked about this being one of the key safeguards. I want to raise a concern in this regard, especially when we’ve looked at other jurisdictions that have used a form of a review committee. So the question is: is it safe? Will it ensure that—the SCENZ, as we know, is different. That’s a role around the registry for medical and health practitioners; where the role of the review committee, in particular, is around where there’s compliance to the laws that have been set in place.

So the trouble that I have with this is that there seems to be a lack of visibility, because, and it has been noted, there is no access to the client data. The amount of data is critically important. If we look at Belgium, for instance, where there is a review committee that’s been put in place, what’s happened there is that when they look at the review committee and the roles that it plays, as mentioned here in clause 20, you’ll see that the three clauses actually talk about the actual functions of the review committee but it does not give the details in regards to requiring those review committees to have access to the client data.

Now, both in the Netherlands and also too in Belgium, it’s quite clear that access to the data is important, because once you anonymise the data, then you lack to get an understanding of, actually, were there cases of coercion? So if we look at, actually, in Belgium, for instance, in that regard, where initially it started off, the safeguard was there and people were reporting. What they found is that there was a number of misreporting. In fact, there was an external review, which happened in regards to the Belgium situation, with the review and the federal state committee that was put in place. What was found was that there were at least 78 percent of cases the doctor said that they did not regard as an act of euthanasia. So already there were breaches in there. Why? Because there was a lack of specificity in regards to what data was required.

So I want to go on the record. The fact is that David Seymour might say this is safe enough. We’ve got two jurisdictions: the Netherlands, who’s been acting since 1973. We heard from Dr Theo Boer, who would have reviewed almost 5,000 cases, and specifically said, “If there is a lack of data, then surely there will be cases that would not be reported.” This is the case in this regard as well. So I want to ensure and put that through.

With that, I want to commend Supplementary Order Paper (SOP) 348, where it clearly states, and I review this here, adding extra subsection (3)(a) and (b): “(3) Subject to this Act, the Review Committee must—(a) regulate its own procedures for performing its functions and duties (including, without limitation, its procedures for handling any complaints about its actions, processes, or procedures); and (b) make its procedures publicly available, in the manner it considers appropriate.” These are important, and I would hope that members across would see that, actually, voting for this SOP is critically important. If we are talking about safeguards, then this review committee needs as much scope and ability to be able to enable it to do its job, as stated by the member, and also too, as has been stated here in review in clause 20.

I also too want to point out that one of the critical areas is that a number of the worst cases will not be reported. We’ve already heard that internationally—and especially in the Netherlands and in Belgium, the estimated number of cases where there is non-consent. In fact, they’ve talked about voluntary euthanasia: non-voluntary and involuntary. In that case, what’s been estimated is the fact there are at least 300 of those cases where there is non-consent, because of the lack of data that is there. And hence the reasons why it’s important to have—what I believe in this SOP is critically important—the scope and the appropriation that the review committee will be able to have at its disposal as well.

In my final moments I want to again go over the other parts of this SOP, which is critically important in regards to the breakdown around ethnicity and socio-economic. The member and others have talked in this House about those who are vulnerable and the impact that they will have. A lack of data that is not at the disposal of the function and role or responsibility of the review committee means that this critical data will not be informed. That means the public won’t be able to report on it. We could have a number of cases, as already stated in those jurisdictions, where there is non-consented euthanasia that’s happening there, and particularly to those who are vulnerable in those countries.

I move, That the question be now put.

I raise a point of order, Madam Chairperson. I raise a point of order in relation to the amount of time taken for the teller to record the votes and return the voting form to the committee. We’ve just had a vote where the teller for the Noes, Amy Adams, was able to count a larger number of votes taking 10 minutes less time to count those votes than the teller for the Ayes, Maggie Barry. People might wonder why that was. I’ve had a member exercise their right to go and observe the voting taking place in the lobby, and they reported that, actually, they saw a group of people, including Maggie Barry, the teller for the Ayes, standing around and talking rather than reporting back to the committee.

Furthermore, I’ve had it drawn to my attention that Maggie Barry composed a tweet which was posted the minute before she came out and gave the voting paper to you, and I seek your guidance about what sort of recourse the committee has if it suspects that a teller is not competently discharging their duty and allowing votes to occur in a timely fashion.

I’ll give that matter some consideration. We’ve got a lot of votes to get through, and I’ll consider that matter as we progress with the votes. The question is that Simon O’Connor’s amendment set out on Supplementary Order Paper (SOP) 328 to replace clause 19(1) on David Seymour’s SOP 259 be agreed to. All those in favour say Aye—

💬 Simon O’Connor: You can’t because you haven’t actually called the result of the first one.

CHAIRPERSON (Hon Ruth Dyson): Yes, I did. I’m happy to do it again for the member, but I did definitely call it—

💬 Simon O’Connor: Oh, my apologies.

CHAIRPERSON (Hon Ruth Dyson): —and pass the papers back.

💬 Simon O’Connor: I then do apologise.

CHAIRPERSON (Hon Ruth Dyson): That’s right. Everyone’s able to make mistakes. Thank you for that apology.

The question was put that the amendment set out on Supplementary Order Paper 328 in the name of Simon O’Connor to the proposed amendments set out on Supplementary Order Paper 259 in the name of David Seymour be agreed to.

I raise a point of order, Madam Chairperson. I move that we report progress, if that’s the right word. I always get it wrong, but you get the sentiment.

CHAIRPERSON (Hon Anne Tolley): No, you seek leave.

Oh, I seek leave—jolly good. I seek leave that the committee report progress.

All right. Is there any objection to that? There is.

The question was put that the amendment set out on Supplementary Order Paper 358 in the name of Anahila Kanongata’a-Suisuiki to the proposed amendments set out on Supplementary Order Paper 259 in the name of David Seymour be agreed to.

Louisa Wall’s amendment deleting clauses 19 to 22A set out on Supplementary Order Paper (SOP) 235 is out of order as being inconsistent with a previous decision of the committee on David Seymour’s SOP 259.

The question was put that the amendment set out on Supplementary Order Paper 212 in the name of Chris Penk be agreed to.

I raise a point of order, Madam Chairperson. In light of how much everyone’s enjoying this evening of democracy, I seek leave for the committee to report progress after it considers Part 4 tonight.

Leave is sought for that purpose. Is there any objection? There is. Well, the opportunity was there.

The question was put that the amendment set out on Supplementary Order Paper 215 in the name of Simon O’Connor be agreed to.

I raise a point of order, Madam Chairperson. Just as a point of order, the ruling was made with regard to matters of business not being a personal vote, and this becomes a party vote, madam.

No. This is not a procedural matter.