End of Life Choice Bill

We now come to Part 2—debate on clauses 6 to 18.

Thank you, Madam Chair. I rise in support of Part 2 and, if I may, to make a couple of preliminary comments. I’d like to advance a series of amendments to Part 2, which are set out in Supplementary Order Paper 259, in my name, which has all of the amendments in a revision-tracked format for ease of reference. I might add that that revision-tracked version has been prepared by the Parliamentary Counsel Office with the assistance of the ministries of justice and health and in consultation with a wide range of external experts—for instance, some of the legal counsel responsible for the application in Seales v Attorney-General. A number of other Government departments and experts have been consulted in the preparation of those amendments. So there has been some considerable work that has gone into them, and by and large, the bill as reported back from select committee remains in spite of all that. But, if I can, I’d just like to address Part 2 in general and some of those changes in particular.

There is a new clause 5A with regard to conscientious objection. Conscientious objection has always been a cornerstone of this bill, and the principle that nobody must do anything under this bill that they do not wish to do. What we’ve done with this amendment is say that it applies to all healthcare professionals who may have a duty under the bill or a duty that arises in any other way in relation to assisted dying and that they cannot be discriminated against on the basis of employment law. That is new clause 5A.

Clause 6 describes what must happen if a medical practitioner has a conscientious objection, and that is that they must tell the person applying for assisted dying that they have a conscientious objection and that the person must contact Support and Consultation for End of Life in New Zealand, or SCENZ, a new office established in the Ministry of Health, to get a replacement medical practitioner. Some people have tried to portray this as referral. There is no way that it could be portrayed as referral—to give a piece of publicly available information that the person must contact the Ministry of Health for a replacement medical practitioner.

Clause 7 is a new clause, which makes it clear that a medical practitioner cannot initiate in any way a conversation about assisted dying. They can, of course, provide information if they’re asked, but they cannot initiate a conversation that is in substance about assisted dying. I’d say to members that, in Victoria, it has been ruled by the authorities that that includes any kind of advertising. There are some people who are anxious about the advertising of assisted dying. That has been interpreted in Victoria as being blocked by the requirement not to initiate a conversation. If you breach that, you can be subject to disciplinary proceedings by the Health and Disability Commissioner.

Clause 8 is the beginning of the process proper for assisted dying. A request is made by a person to either their medical practitioner, or a replacement medical practitioner if there’s been a conscientious objection, and at that stage we go through quite a comprehensive process where the doctor has to talk to the person about their options and their prognosis, and has to seek to talk to family members, so long as it’s not in breach of the person’s privacy. They have to talk to other people engaged in the person’s care. They have to examine their notes. They have to talk to them at times suitable to the development of their condition.

With people with a rapidly advancing condition, that might be quite short time increments; with somebody with a longer prognosis, that might be quite long time increments, but, nevertheless, there is an extensive process under clause 8 where the person has to have it made very clear that it’s their choice. They can say no at every time. It’s important, for instance, that the person must be told about their other options for care. Now, of course, that’s just normal—that’s just informed consent—but for those who want to see other options somehow made mandatory or people being made aware of other options, we have covered that in clause 8.

Clause 9 is that, having gone through that process, if a person still believes they’re somebody who would like to request assisted dying, they then have to confirm that request in writing. They must sign a form. The form can be signed by somebody else if they are physically unable. There is provision if a person is physically unable to sign, but the person that signs for them must be somebody who has no direct benefit from the person’s death or no potential to benefit from the person’s death.

If the person has confirmed their request in writing, then we get to the first opinion. The doctor must examine the person. The doctor must read their notes. The doctor must come to the conclusion that the person is a person eligible for assisted dying according to the criteria set out in Part 1: they must be over 18; they must be a New Zealand citizen or permanent resident; they must have a condition that the doctor judges likely to end their life within six months; they must be a person who is mentally competent and able to make the decision, which is also a criteria that we discussed in Part 1, and it’s defined there; and they must believe—and this is critical—that, in their view, their suffering cannot be alleviated in any other way, and that becomes important later on. If the doctor comes to that conclusion, then they must refer the person’s file back to SCENZ, who then take a second doctor, who, in clause 11, goes through the whole process again in clause 11.

Clause 12 is the third opinion. If either of the first two doctors in clause 10 or clause 11 reach the conclusion that the person would be eligible for assisted dying were they mentally competent to make the decision, but they’re not sure, then they have to send the person to see a psychiatrist. This is a change from the bill as introduced or reported back from select committee. It was a psychologist or a psychiatrist. We’ve had some discussions with various people and concluded that, because the person has a medical condition, it should be a medical expert—that is, a psychiatrist.

Finally, there is a decision. If any of the three medical practitioners involved—either of the doctors or the psychiatrist—do not believe the person is a person eligible for assisted dying, then the answer is no. Any of them can veto it. At that point, clause 13 sets out how the person must be told, and the results of that decision must be reported to the registrar. Throughout this process, the registrar, who is an officer of the Ministry of Health, collects all of the paperwork, all of the forms, and all of the records of what happens through this assisted dying process.

Clause 14 is what happens if the answer is yes—that those two or, potentially, three medical experts all agree that the person is a person eligible for assisted dying, the criteria of which I set out a moment ago. If that is the case, then they choose a time and a date and they make provisional arrangements to end their life at a time of their timing and at a time of their choice and on their terms. Finally, clause 15 is the making of the provisional arrangements.

Clause 16 is very clear, and this something new from the bill as reported back from select committee, which is that the person can actually choose to defer within a six-month window. I think this is really critical. Evidence from offshore is that there is a palliative effect simply from having the choice. Once people know that they have the choice about how and when they die, if they want it, then that actually has a huge, positive effect on their wellbeing. We’ve made it that a person, once they have that choice, can change the date. They can change their mind at any time. They can change the time at any time within a six-month window, given that that is supposed to be their prognosis from the two doctors.

So what we’ve got in Part 2 is a process. As you can tell from the, really, quite a glossing-over sort of summary I’ve given, I’ve mentioned really a small portion of the detail in this part, but I hope I’ve summarised it well. There’s a very rigorous process. There’s many checks and balances, there’s many safeguards, and there’s many medical experts and a great deal of medical expertise engaged in deciding whether or not a person is somebody who is eligible for assisted dying, and, of course, the definition of that is something that is decided according to the definitions that this committee debated and agreed to in Part 1.

So I’ll try and keep my contributions brief, but I hope that that description of Part 2 and the changes that I’m proposing and asking the committee to agree to suffices to begin this debate. Thank you, Madam Chair.

Thank you very much, Madam Chair, for the opportunity to speak in this, the committee stage of the debate on the End of Life Choice Bill, and, more particularly, on Part 2. There is so much detail that can and should be discussed within this part. In a way, it is really the most crucial part of the bill because it contains the devil in the detail and, indeed, the lack of detail in relation to the way that a person is to make this decision and for that to be verified as being truly their decision and a matter of choice. So I say to colleagues who are in favour, generally speaking, of euthanasia and assisted suicide—those who are in favour of the concept of what is proposed in this bill—that it is all the more important for those members to pay attention to the detail of the debate that we will have this evening and, no doubt, into next week as well around the lack of safeguards and protections for the most vulnerable. Of course, it is those who are most vulnerable, those who are recently in receipt of a diagnosis and prognosis of terminal illness, who would be seeking to avail themselves of these choices.

I’d like to take a few minutes just to frame the debate, somewhat, so that we can understand clearly what it is that is up for debate and discussion tonight. I won’t seek to go into a huge amount of detail in a way that would make later contributions repetitive, because I know that colleagues who are nervous about the ramifications of the bill will have much to say in certain key areas.

On that note, I want to highlight to the committee that the proposal that’s put in front of us, not only in the member’s bill itself but including the Supplementary Order Paper (SOP) proposed by Mr Seymour, contains details that are actually significantly different from those in most other jurisdictions, and not in a good way—for example, the lack of witnesses being needed to the signing of a euthanasia request; the fact that a person only has to make one request, not multiple occasions; and that medical practitioners don’t have to be qualified in the field of that person’s illness. We’ll get to all that detail, no doubt, but it’s worth noting in response to the comments made by the member himself earlier—and he specifically referred to a psychiatrist needing to be involved in the signing off—well, we’ve heard last time, and I won’t go back into that detail too far, that the definition of a psychiatrist is someone whose scope of practice includes psychiatry; so not even someone who necessarily has a particular qualification in that area or is a member of that relevant professional body and so forth. So that’s perhaps an example of the member himself highlighting what he thinks is a rather neat safeguard but, in fact, on closer inspection, proves to be nothing of the sort.

Similarly, the member has talked about advertising and the fact that, in Victoria recently, apparently there’s been a ruling that says that it’s not the same thing to advertise assisted dying services as initiating a discussion, such as his bill would preclude. My question, then, to the member—and, actually, probably more to the point, members of the House who are interested in making good law—is: why does this bill not specify such a thing if that is what he intends? Will he leave it to the ruling of a New Zealand court, if the matter should go to court in the case where a wrongful death has occurred or may have occurred, to get that sort of certainty? That is the purpose of this House: to provide some measure of certainty, and certainly protection, in life and death matters no less than others.

Similarly, we hear from the member that a person cannot sign on behalf of someone who is making an assisted dying request—or seemingly making an assisted dying request—if that person who is signing would benefit, but there is no need to examine, for example, the last will and testament of the person who’s making it. So how that’s to be established in any given case, how that’s to be documented, how that’s to be verified, how there’s to be accountability in these matters is very unclear from the bill and, in fact, the absence of that evidence is really evidence of the absence of the lack of thought and detail that’s required if we’re going to pass legislation of this sort of magnitude.

So I’d like to emphasize, first, the kinds of areas that I think members would be interested in speaking to tonight and then, also, start looking at in some detail the SOP in my name regarding coercion. But, before we get to that, I’d just like to highlight the importance of the provisions that will be discussed and debated in relation to freedom of conscience rights. There are a number of different SOPs on those that will be before the committee tonight. One of those is in the name of the Hon Michael Woodhouse, who has some knowledge and experience of the medical and health profession, and he’s got some excellent thoughts in relation to organisations that would be subject to the bill.

I’d just like to make a plea to you, Madam Chair, and your fellow presiding officers to recognise and understand that conscience rights for an organisation are different in nature from those of an individual practitioner. So I would respectfully encourage you not to consider that as being one and the same and, therefore, potentially out of scope if there were to be some perceived overlap there. Other proposals in the space of freedom of conscience relate more to the individual practitioner but strengthening those that have been put forward by Mr Seymour. Again, along the theme that, for those who are in favour of the principle of assisted dying and may be in favour of the bill more generally, to understand and acknowledge the severe danger to the medical profession—probably the legal profession too if they have to interpret too much of this stuff—is a crucial theme of the Part 2 debate.

So please allow me then to turn to the subject of coercion and, more particularly, the proposal that I’m making by way of SOP 302. The idea is to propose practices that will be such that the legislation, if it were to pass, will be less unsafe than if it were to pass in its current form. I do not claim, for reasons of modesty, and understanding human nature and also the way that the law in medicine has always operated and will always operate, that this would be a complete defence to practices of coercion, undue influence, and so on, but I do claim that it would be at least a step in the right direction. Again, I would respectfully encourage members of the committee, whatever perspective they have on euthanasia in general, to understand that if the starting point and the philosophical basis for allowing this practice to creep in to what we have so far called healthcare in this country, then at least we can ensure that it is a person’s choice that is being exercised in this way.

The detail of my Supplementary Order Paper is based around a couple of key concepts. One is the desirability of setting up a panel of practitioners—an independent panel, and that’s a point to which I will return shortly—that will have the mandate to consider individual cases of requests for assisted dying, as that term is defined, and I’ll talk briefly now about the way that the panel is put together and then, if time allows, get on to the functions of the panel and its procedures and so on. I appreciate that I might not get the opportunity to do that fully within my remaining time in this call, Madam Chair, so perhaps I might seek your indulgence and indeed a call later on for that purpose. For now, though, looking at the nature of this independent panel, the idea is to determine any individual case where the pressure is present in the situation of a vulnerable person—one who has been diagnosed with a terminal illness—and so the composition of the panel is important because it’s the people who will comprise the panel who will be making these decisions that are so important to understanding the types of coercion that might arise. So their qualifications in different fields will be necessary to achieve that properly.

So, then, first I note that the panel will be independent in nature. The idea is to have a decision maker outside of the medical practitioner attending, and then the so-called independent medical practitioner, and the panel would have no fewer than 12 members at any time. Within that, a committee of at least four members would make the decision on any individual application. There’s a certain amount of bureaucracy and a certain amount of administration inherent in this, and I do acknowledge that, but I also feel that in such a significant matter as life and death under this bill that it’s not an unreasonable thing to expect and to institute. So, first, a chairperson, who must be a District Court judge—the idea there being to have someone who is well versed in the practice of weighing evidence, often from two sides, albeit that a non-adversarial scenario no doubt would hopefully prevail in each of these types of situation, but also expert medical practitioners in the area of geriatric care, psychology, and adolescent mental health.

Thank you, Madam Chair, and thank you for the opportunity to take a call on Part 2 of the End of Life Choice Bill. I would like to start my contribution—one of a few which I hope to make this afternoon—firstly in regards to the Supplementary Order Paper of Michael Woodhouse, No. 295, and in later contributions also take some calls in regards to some of the Supplementary Order Papers that I’ve also put on the Table.

The Supplementary Order Paper in the name of the Hon Michael Woodhouse speaks to the area of conscientious objection, and I respect what the member in charge of the bill had to say in regards to the provisions which are already in place in his changes that he is making in his Supplementary Order Paper. What Michael Woodhouse’s Supplementary Order Paper is designed to do is to provide additional protection and conscientious objection rights for organisations which play a role in the provision of aged care in New Zealand. I’d like to talk about this and frame it in a way that it is about the importance of providing these organisations the opportunity to exercise their choice and their freedom in their decision as to whether they wish to provide assisted suicide services or not.

This Supplementary Order Paper doesn’t undermine the intent of the bill, but it does ensure that organisations who are involved in end of life care are able to make a choice as to whether they wish to be involved in providing these services. I’d like to draw the committee’s attention to the very excellent work which was sent around by Hospice New Zealand recently, and the commentary that they provided in regards to this Supplementary Order Paper, where they said, “We believe this would allow organisations such as Hospice the ability to be upfront with patients, families, staff, volunteers, and the wider community that euthanasia will not be performed on the premises by a health professional or by staff employed by that organisation.” The inclusion of this amendment would give hospices and others the right to choose whether they object or not as an organisation, and would allow hospices to operate under their founding tenet of neither hastening nor postponing death.

Now, this issue that we’re debating here tonight, and the bill around whether we allow assisted suicide or not in our country, is not what Part 2 is about. Part 2 is about the process, as the member in charge has already outlined, but is also around whether the doctors, medical professionals, those involved in the field have the choice to be able to be involved in this service or not. I believe that that should also be extended to organisations, many of which do come to this, whether it’s a faith base, whether it’s an ethos or a value system which they subscribe to as a company, whether it’s something which is part of their charter in terms of how they were set up—I think of a business in my electorate, Ambridge Rose, which provides aged-care services to hundreds of people in the east Auckland area every single year. And I note that this is an issue which, for them—they are in the business of providing healthy living and to ensure that death is not assisted by assisted dying. That is the decision that they’ve made. But, without this provision in this Supplementary Order Paper, they will potentially be put in a position where, when they’re bidding for contracts—whether that’s through the district health board or the Ministry of Health—they will be provided with the choice of either taking the contract and having to provide assisted suicide, which goes against their ethos, or not applying for the contract at all. So this Supplementary Order Paper does what I think are four important things.

Firstly, it allows, under subclause (3), the opportunity for an organisation to “(a) promote, publish, or otherwise publicly communicate that it is an organisation that has a conscientious objection to providing assisted dying:”. So, members and Madam Chair, that is about ensuring that the organisation is able to be upfront and clear with those people who may wish to use that service as to whether they provide it or not. Secondly, “(b) include in its conditions of admission, residence, care, or other service that it is an organisation it has a conscientious objection to providing assisted dying:”—so, that is about ensuring that the organisation can put that—[Time expired]

Tēnā koe, Madam Chair. Tēnā koutou katoa. I specifically want to speak to two Supplementary Order Papers. The first is Supplementary Order Paper (SOP) 209, in the name of Simon O’Connor. The reason I’ve chosen his SOP to speak to tonight is really the nullification, I’ll call it, of the current clause 6(2)(b), which is proposed by the proponent of this piece of legislation. Essentially, the proposition from Simon O’Connor is that if you conscientiously object to undertaking end of life choice requests as a medical practitioner, then, as is proposed by David Seymour, that medical practitioner must provide information about the Support and Consultation for End of Life in New Zealand Group, which will then provide the patient with the name and contact details of a replacement medical practitioner.

I actually think this speaks to the whole issue of individuals not participating in a practice, as Simeon Brown has just talked about, that may contravene their values and beliefs. But, at the heart of the second aspect of the current proposed clause 6(2)(b), it is actually about a duty of care. So my proposition is that you may not, as a medical practitioner, want to support your patient in their choice of end of life choices, but at minimum you should provide them with an alternative. I base it around the concept of duty of care, because actually it’s a legal obligation which is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others.

I guess, within the context of that relationship between a medical practitioner and their patient, are they doing harm to them if that patient has requested end of life choice information or support and they then choose not only not to provide that service to their patient in the first place but then to refuse to actually ensure that that patient has access to adequate and sufficient information to enable them to then engage with a medical practitioner that then does want to assist them in terms of accessing, if this bill goes through, end of life choice options?

For me, that also dovetails into SOP 295, in the name of Michael Woodhouse, because, essentially, his proposition is that organisations should be able to express a conscientious objection in the provision of end of life choice options. Again, for me, definitions are incredibly important. A duty of care, from an organisational perspective, from what I’ve been able to discern from medical law definitions, is that a hospital or organisation providing medical services would normally owe a duty of care to a patient of a doctor employed by the hospital or provider of medical services.

So, in fact, the issue of conscientious objection by an individual, I think, requires them, if they are to practise from a patient-centred approach perspective—and I do want to draw on my own SOP in terms of that particular concept, because if we look at modern concepts of patient-centred care, it is about respect for patients’ preferences and values. It is about providing emotional support. It is about providing physical comfort—information, communication, and education are critical—continuity and transition; coordination of care; the involvement of family and friends; and, fundamentally, it’s about access of care.

So I think if we look at it from another perspective, and that is presuming end of life choice does become an option, should a patient, if their medical practitioner does not want to offer access to end of life choice—at minimum, should that medical practitioner actually ensure that they have information through the Support and Consultation for End of Life in New Zealand Group to find somebody that will enable them to exercise their right as a patient to end of life choice?

I haven’t quite finished, and the reason I am going to ask for another call is because I’ve found an example of a district health board—[Time expired]

Thank you, Madam Chair. I would like to base my contribution, my first contribution this evening, on Supplementary Order Paper 321, in the name of the Hon Maggie Barry. This pertains in particular to new clause 18C. It is entitled “Support person to assist vulnerable elderly person”. I want to remind the House, and in particular, though I know that is in committee stage and part of the goal is to contribute to the member who’s in charge of the bill—but the truth is, and the reality is, that actually part of this debate is also about convincing, the opportunity to debate and deliberate, of all colleagues in the House, being as it’s a conscience bill.

So I’d like to remind colleagues of the fact that the reason that we’re here and we’re talking in particular to this Part—I want to talk to this Part in particular—is that there were almost 39,000 submissions. In those submissions, I want to acknowledge them and I want to be able to use and draw from some of those submissions in my contribution, because in the second reading many of the statements that were made there were about, if we go into the committee stage, that we would also allow due diligence; we would give the time and the respect that had been afforded throughout the select committee process, which came to an impasse where they were not able to come to a decision. So I want to be able to reflect and to use some of those contributions from those who made those submissions. As I say, nearly 39,000; 91.4 percent opposed to the bill—91.4 percent opposed to the bill. And I want to reiterate that because we do a disrespect to those people, and the contributions I want to make in this part in particular will actually contribute to the points that I want to put across.

This Supplementary Order Paper (SOP) particularly deals with “to assist vulnerable elderly persons” in this case. It talks about, in 18C(1): “This section applies where a person who is eligible for assisted dying is aged 65 years or over.” In 18C(3): “In addition to [those] other requirements of this Part, a vulnerable elderly person must be offered the assistance of an independent support person who—(a) possesses in-depth knowledge of the cultures and practices within the community the vulnerable elderly person is from;”. Many times we have heard, not only in our communities but also too even in this House, that vulnerable elderly people have been abused.

I want to read from one of the submissions—again, one of the 39,000 submissions that came through. This is from a practising geriatrician, who says this—and I quote—“In my practice as a geriatrician I frequently see cases of people entering residential care, or making health decisions, not because this is their preferred decision, but because it is ‘best for their family’. It is important for the committee to note that elder abuse is a) common in society b) frequently unreported and c) most often perpetrated by those closest to the individual. As such these familial reasons quoted for desire of hastened death are highly open to pressure and coercion, which is unlikely to be documented”. We know from Age Concern, who also submitted, and it goes to the point of this SOP, that 75 percent of those that are reported in regards to elder abuse are from family members.

This SOP also too, in clause 18C(3), notes the fact of the importance of having knowledge of cultural practices. There are many times in the debates that were held in our communities—I remember in Porirua in particular, the Pasifika community that were there, they were outraged when supporters of this bill used a poll that said 63 percent of Pasifika people supported euthanasia. They were outraged to the point they became angry. They stated that this is not true, this is not the fact, this is not our culture. Our culture of care is to care for the dying and the sick. It’s the aroha, it’s the love that they give throughout that process that takes them through to their point to their final days.

So this point and this clause, I think, is critically important. We have such a diverse society in a community, and I am concerned, along with others—and I know it’s not only in Pasifika communities; it’s in Māori communities, it’s in other ethnic communities—that we could have a situation where (1) people are unaware of what their other options are, and (2) it becomes a convenience, as we’ve seen in other jurisdictions overseas. Belgium is a good case in point, where there were cases where, actually, through non-consent, people were euthanised. It doesn’t get any more serious than this. I believe that there should be serious consideration to this SOP 321, in the name of the Hon Maggie Barry, that there be support and assistance for the vulnerable and elderly person, in particular for cultural issues in our communities.

Thank you, Madam Chair. I’d like to make my contribution at this stage on Part 2, clause 8 of this bill. I’d just like to concur with what the previous speaker, Alfred Ngaro, has said about, as members of this House—particularly members who voted to get this bill to this stage because they wanted the scrutiny, because they wanted to make this a better bill. So I hope that the members who have wanted to get this bill to this stage come to the committee of the whole House and actually contribute to making this bill better. So I’d like to see those members in the Chamber today.

Clause 8 is the choice clause. Proponents of this bill say that we should pass this bill because it’s about giving people a choice, and the member for this bill, David Seymour, has, I note in an earlier debate, said, “What this bill is about is giving choice and safety, giving people an ability to make a particular choice should it suit them. It doesn’t take anything away from all of the other choices people might have; it gives an additional choice to some people who might want it.” So why are we talking about safeguards if it’s all about choice? Either these requirements are a cynical way for proponents to pretend to care about people being abused under this law when they don’t, or maybe the proponents are gradually realising that this law is dangerous, so as time goes on, they’re introducing more rules.

The truth is that there are obvious reasons people might be under pressure—the ill, elderly, and pressured people into euthanasia. My colleague Melissa Lee, in the last committee stage, gave a glaring example of the abuse that does happen in this case. Proponents are pretending that the rules can deal with that danger, and so this is what clauses 8 to 16 are supposed to do, but they are entirely inadequate to prevent abuse. And if I could just also add, there is a whole spectrum of scenarios that can occur, that will occur under this bill, and in particular there are two types of abuse that New Zealanders will be at risk from. First, straightforward elder abuse, which is already, unfortunately—it’s sad, but it is well documented in this country—a tragedy. This law gives elder abusers the ultimate weapon. Second, subtle pressures around decision making—these pressures can come from family, from the healthcare system, and society as a whole. The mere existence of this bill is a subtle pressure. Choice to one is pressure to another. It may manifest as a subtle pressure; it may also manifest as a not-so-subtle pressure, depending on the environment that that person is in.

But if I could just also use this time to please highlight the Supplementary Order Paper (SOP) in my name, which is SOP 317, which has, in clause 9, just tightened up some wording around people who may wish to change their minds after they’ve gone through the process of section 8. It is not unusual for elderly people to want to change their minds. It is not unusual for them to change their minds on a daily basis or weekly basis, depending on the nature of their care, depending on the nature of the relationships of the people that are close to them, the people that are around them. So, in tightening up that wording, in my SOP 317, in clause 9(2)—to replace “wishes to proceed,” with “still appears to wish to proceed, and has done nothing to indicate that they may have changed their mind after previously expressing a wish for assisted dying under section 8”.

So I please urge members of this committee to at least consider the amendment that I’ve put down in my name, No. 317, as some way to go to tightening up that wording and to providing some measure of safeguard in that particular text. Thank you.

Thank you, Madam Chair. I rise to speak at the committee stage of the End of Life Choice Bill. This is Part 2. It outlines the process of how euthanasia would actually be delivered and how it would work in process and in practical terms. So, as other colleagues have pointed out, we have a range of Supplementary Order Papers (SOPs) and amendments that are intended to make this bill as safe as it is possible to be, because the sponsoring member might like to stand up at some point and tell us exactly how many amendments are in his SOP 259. It’s sort of over about 50, I think. Some are minor and technical; some are profound. They still don’t make any difference, in our view, to the safety of this bill. This part of the debate will focus on what this bill does not do, and that’s plenty. It does not define the standards of safety and the standards that need to be applied to something as important as a life and death issue and what categories there are in terms of the eligibility. These are not included in any meaningful way, and what protections are not there, and there are plenty that are not there. In fact, the SOPs that I’m going to be talking to and have tabled are around elder abuse, coercion, and the protection of New Zealand’s most vulnerable, because this bill doesn’t even come close to looking after their interests.

There are a number of things that we will draw attention to as the debate continues. A panel of independent practitioners has been proposed by my colleague Chris Penk. I think that that is an excellent idea. It is an excellent mechanism for ensuring that people have the right and the time to really consider what it is that they are signing up for. When we look at what’s available in other jurisdictions, there are things that include: it does not require witnesses to the signing of a euthanasia request—that’s international. A person does not have to make multiple requests, as they do in other jurisdictions. Medical practitioners do not have to be qualified in the field of a person’s illness. Again, would the sponsoring member like to answer why it is that these are in other jurisdictions but not in this one?

Even the basic protections are not there, and when we look at the concerns expressed by experts who deal with life and death scenarios every day, we have consulted with them widely on the Supplementary Order Papers and amendments that we are putting forward tonight. Without people trying to be dismissive of what we are doing here, we are representing—as the Hon Alfred Ngaro has said—some of the 39,000 people who expressed their concerns to the select committee. It is here in Parliament that we can really define them.

So let’s look at clauses 8 to 16. They’re supposed to deal with the dangers and the problems that might occur. They are woefully inadequate, which is why this Supplementary Order Paper suggesting and wanting a person who is a support person to be provided free of charge, either by the Ministry of Health or by the Ministry of Justice—we’re open to discussion around that. But for a vulnerable elderly person who is, potentially, being coerced—and that can certainly take many subtle forms that are not easy to detect—it is not easy for an older person to be able to articulate it. For example, an elderly Tongan woman came before our select committee and made submissions. She said her English language was not good enough and that she would like somebody to support her through the process of inquiring about assisted death. She would like somebody who can speak in her language and can translate for her, and who also understands the cultural endeavours that she has always lived her life by and her community has. So it’s very important that those individuals, those support people, are available for older people who, perhaps, are not particularly savvy with dealing with the medical profession. They are people who are weary and worried and may be being coerced.

Picking up coercion is a really difficult thing, so our suggestion—mine in the SOP; in subclause (3) of what I propose—is that that be in writing by the medical practitioner so that there is time for consideration, because all of this stuff is too fast. There’s no cooling down period. There’s no real ability to consult with others, but the attending medical practitioner, as soon as practicable, must give in writing, soon after the request is made, the offer of a free support person, and providing that vulnerable elderly person with that level of an individual who can speak to them about the concerns that they have. So these are some of the issues that we’ll be talking to in more detail over the next couple of hours. Even if you are supportive of euthanasia in principle, this is certainly not the bill to deliver it.

Thank you, Madam Chair. I rise to take a call before the dinner break, and hopefully I’ll be able to address and alleviate some of the concerns that members have raised to date, beginning with Chris Penk. He said something that’s been said a number of times, also by other members, that there’s only one request. Well, actually, as I read out the processes, there are a number of requests. At various times in the process, a person has to actively initiate—they have to make the initial request. They have to then confirm that request in writing. They then have to agree to set a date and time. They then have to make preliminary provisions for assisted dying to occur. They then have to be told multiple times that they can change their mind at any time and, indeed, they may do that. So the idea that there’s only one request made is simply untrue.

We’ve been told several times that doctors don’t need to be qualified. I tell you, if I thought that was true, I would not go near a hospital in New Zealand. But the fact is that medical practitioners are required to be qualified and they are required not to practise outside their scope of practice. So you will not find doctors in New Zealand doing things that they are not able and qualified to do. If they were, there would be a much bigger problem in New Zealand than simply with this bill.

Simeon Brown talked about the Michael Woodhouse Supplementary Order Paper (SOP). I think it’s quite an interesting Supplementary Order Paper to raise. It attempts to exempt institutions from something that they’re not required to do. Let me just say that again: nowhere in this bill is any institution required to do anything. I don’t see where the logic is in being able to object conscientiously to doing something that an institution isn’t required to do in the first place. That may be why it is that, in every jurisdiction that’s legalised assisted dying, opponents have brought up the possibility of such a provision but, in Canada and in both states of Australia so far, it has been rejected.

Interestingly, Michael Woodhouse told me that institutions in Canada were having to close down as a result of assisted dying being legalised there. I’ve challenged him several times and I’ve got the emails. Unfortunately, he couldn’t provide evidence to back up that claim. I think, possibly, he had an unfounded concern to start with. Furthermore, the amendment that Michael Woodhouse has put up also makes it impossible to have a contract for providing assisted dying between a district health board and any organisation. That goes beyond simply protecting people’s choice. That actually makes it impossible to have assisted dying contracted. That’s a contradiction with the House’s agreement that, actually, assisted dying should go ahead.

I might also skip to Maggie Barry, who said there should be a free support person in assisted dying, funded by a DHB, which would be made impossible by Michael Woodhouse’s amendment. In any case, I go forward to Louisa Wall. I want to thank Louisa Wall for her contributions, and I agree with her that the amendment she discussed would create access issues, and that there is a duty of care for practitioners. I want to thank her for raising that. Alfred Ngaro talked about Maggie Barry’s SOP. He talked about unconsented assisted dying in Belgium. That’s something that people have brought up in this debate for years now, and we know that it is incorrect and the evidence is there. It’s unfortunate that people persist in fudging the issue that way.

I think it is wrong, also, that we would put in law that people would be somehow treated differently in the law according to their cultural or ethnic background. I want to make a broader point about this in this debate, because all my life as a New Zealander I have stuck to the mantra that it is wrong to judge a person based on their superficial characteristics. You should take every person as you find them and judge them by the content of their character, not the colour of their skin or anything else. Too often in this debate we’ve had people stand up and say that persons of X identity all think the following way. We’ve had it from Melissa Lee with respect to Koreans, we’ve had it from Alfred Ngaro with respect to Pacific people, and I can tell you there are people in every single group in this country who are for assisted dying and against. It is time that we stopped stereotyping people like that.

Agnes Loheni got up and said, “Why have safeguards if it’s all about choice?” Well, the simple answer to that is that the safeguards are there to ensure that the choice is being freely made. Maggie Barry finally got up and asked, “Could there be a support person?” She also raised the multiple-request issue that I’ve addressed. That’s all I have to say about that.

Tēnā koe, Madam Chair, tēnā koutou katoa. I stand in support of Supplementary Order Paper (SOP) 302, authored by my colleague Chris Penk, which is an amendment to SOP 259, by the proponent, that seeks to amendment the End of Life Choice Bill. In particular, I speak to new clause 18C. My contribution is on the basis of SOP 302, as it seeks to require the establishment of an independent panel of practitioners, experts in their respective fields, tasked with determining whether pressure had indeed come to bear on a person’s decision to seek assistance—

CHAIRPERSON (Hon Ruth Dyson): I’m sorry to interrupt the member, but the time has come to adjourn the committee for the dinner break. The committee will resume at 7.30 p.m.

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

Thank you, Madam Chair. My contribution is to the basis of SOP 302, as it seeks to require the establishment of an independent panel of practitioners, experts in their own fields, tasked with determining whether pressure had come to bear on a person’s decision to seek assistance to end his or her life—pressure that has, effectively, coerced the person to arrive at that decision, that wish, to end his or her life.

Over the past few months that I have been a member of Parliament—just coming up to 3 months now—what has struck me the most is that beyond the rhetoric, beyond the many words said in the debates, there is an overwhelming desire in this House by all its members to protect and care for New Zealanders, especially the most vulnerable. The coalition Government does in fact refer to most if not all that they do as related to wellbeing. In plain language, who are the most vulnerable in New Zealand and the rest of the world? Everyone will surely agree and not contest that infants and children, our youth, the disabled, and the elderly are the most vulnerable.

I raise a number of facts: first, that the Royal New Zealand College of General Practitioners, in their submission to the Justice Committee, labelled the End of Life Choice Bill’s coercion safeguards as problematic, stating that—I quote—“The coercion of patients will be impossible to discern in every request for assisted death.”; second, that the Disability Rights Commissioner described the bill as “inadequate and unsafe”, stating that it undermines the position of vulnerable New Zealanders and that it poses significant risks to them as individuals and as groups; thirdly, that the United Kingdom courts, from the High Court to the Supreme Court, and the Irish courts—the High Court and the Supreme Court—and the European Court of Human Rights have rejected the 2012 judgement of Carter v Canada, which found that risks inherent in assisted dying have not materialised.

I would think it difficult for anyone in this House not to reject the position that one doctor can, without fail, identify elder abuse when an elderly person presents with no physical signs of abuse. It is common knowledge that the elderly can appear even fiercely independent as they try to assert a decision they have made, even though pressured to do so. In this regard, how can one doctor be able to identify psychological abuse and/or financial abuse, both of which may not readily present?

I would think it difficult for anyone in this House not to reject the position that one doctor can, without fail, identify subtle pressure exerted by family members or friends, even medical practitioners, that have, effectively, coerced an elderly person or a young person to wish to end his or her life. Again, such pressure can only possibly be determined by a lengthy course of analysis—certainly not as easy as the proponent suggests—preferably by more than one expert skilled in the ability to ferret out the truth of whether such pressure did exist.

I would think it difficult for anyone in this House to reject the position that one doctor can, without fail, identify internalised pressures experienced by the persons themselves, such as feelings of abandonment, of being unwanted or a burden to family. Thank you, Madam Chair.

I want to speak to the important Supplementary Order Paper that deals with the issue of family in clause 8. It is my view that, as Part 2 stands, we are setting up a legal regime where a person can take their life without any knowledge from their partner, their married husband or wife, and where they can do so without any knowledge of their children until after the event. Now, I’m one of those that believe that family is the most important social institution in our society and that it’s actually at its most important at the beginning and end of life. Now, no one understates the emotional importance at the time when someone may be terminally unwell, where they are infirm, or elements of their life, but I find it quite obscene that we are considering a law in which that decision can be made without any requirement for family members to be informed.

So my Supplementary Order Paper 260 amends clause 8 and requires a person’s direct family to be informed before the event. That is—and I’ve been quite specific with “direct family”—a husband, wife, or partner, a mother or father, or a child. Now, it is my view that they have a right to know that someone may be considering assisted suicide. I’m not saying they have a veto. A person still would have the right to have the decision, but to exclude them from the process is for this Parliament to treat the institution of family with gross disrespect. I would feel awfully insulted if my mum or dad made the choice that’s provided for in this legislation without me being included, and I equally say it would be wrong for me to make such a decision without my mother and father being able to be informed that that was being considered.

I also want to argue that it’s a really important safeguard. One of the real worries that I have with this legislation is the issue of undue influence. I’m sorry; the idea that a stranger doctor is going to be able to determine whether a person is subject to undue influence, with very little knowledge of the person’s family background and the like, I think is a really important gap in the law. The truth is that it’ll be a family member that knows that, actually, “Do you realise that brother Fred has been trying to get their hands on the farm for the last 20 years and is having inappropriate influence over this, that, or the other relative?” That sort of family knowledge and requirement for them to be involved in the process, I think, provides a significant level of additional protection, and, most importantly, it realises and recognises that we aren’t islands in our lives—that, actually, the relationships that we have with our parents, with our partners, are really important.

So I really challenge all members of this Parliament to think about my Supplementary Order Paper on clause 8, which simply requires that the direct family be informed prior to the event. I ask and challenge members to think about their own personal circumstance and whether they would be comfortable that their partner, their son or daughter, or their mum or dad could make such a crucial decision without them being informed until after the event. I really say that this Parliament often gives lip service to the importance of family. Here is an opportunity for us to actually say, “These relationships matter. The institution of family matters.” Having a legal husband, wife, partner or the like matters, and for such a hugely important decision to be made without any involvement of family is insulting to that institution.

Thank you, Madam Chair. I wasn’t going to begin by talking about clause 8 but I just want to endorse the words of the Hon Dr Nick Smith, who, I think, has just very eloquently and persuasively set out why it is so crucial that family must be part of this particular choice given the gravity of—sorry, that’s a bad pun, but the severity of the issue. I too think that most families around New Zealand are the best people to know honestly and sincerely what the wishes and the circumstances of those who might be in this position would be. As Dr Smith has said, to be shut out of that decision at probably the most serious point in one’s life would be something that would be very difficult to cope with and possibly never forgotten.

I do, in this call, want to speak in support of Supplementary Order Paper 295, in the name of my colleague the Hon Michael Woodhouse, which is, in itself, seeking to amend Supplementary Order Paper 259 in the name of the member in charge of the bill. There were some members who had spoken on this particular amendment before the dinner adjournment, but as we’ve had that break this is the first opportunity to return to it—it refers to the issue of conscientious objection. I want to commend the member in charge of the bill for the fact that in his amendments, which he has tabled, under Part 2 new clause 5A (1), he is proposing that “A health practitioner is not under any obligation to assist any person who wishes to exercise the option of receiving assisted dying under this Act if the health practitioner has a conscientious objection to providing that assistance to the person”. I’d be very surprised if any member of this House would be opposed to that particular provision, and I commend the member for adding it to the substantial body of amendments that he’s put forward. But I am puzzled and disappointed as to why, having adopted that logic himself in relation to health practitioners, he has indicated his opposition to the amendment in the name of the Hon Michael Woodhouse, who, unfortunately, because of his commitment to parliamentary business overseas, is unable to speak at this point in favour of his amendment. So I hope the committee will enable me, perhaps, just to put into the record some of the comments that he has made to explain why he has tabled this particular amendment, which is designed to provide protection for organisations that have a conscientious objection to assisted dying being practiced in their facilities.

So the difference here is that we are talking about organisations, and he’s made the point that the sponsor of the bill has proposed an amendment offering protection to health professionals—and I’ve just read it out—who have a conscientious objection to participation in assisted dying. As Mr Woodhouse has been at pains to state, he is simply asking for the same protection to be extended to non-Government organisations. He goes on to make the point that many organisations presently offering aged care, long-term hospital-level care, dementia care, and palliative care were established by groups whose ethos is grounded in beliefs that are opposed to assisted dying. They may be faith based—and much of the opposition has come from faith-based concerns—but by no means all. He’s making the point they may be faith based or they may have a mission of care that recognises that dying is a natural part of life and that, while good care at the end of life is important, death should not be hastened.

The final point I want to just highlight in Mr Woodhouse’s submission is that there was widespread concern amongst some of these providers that, should the bill pass into law, pressure will be brought to bear on them to allow health professionals to enter their facilities to provide assisted dying and that Government funding could be conditional upon that service being provided. His amendment, therefore, is designed to ensure that they have protection from that pressure. I hope that all colleagues will look very closely at that particular amendment, for we have received overwhelming evidence and concerns from organisations such as Hospice New Zealand that absolutely bears out that concern. They’ve made the point that, as the national organisation representing all hospice services in New Zealand, providing palliative care to more than 19,000 people each year, Hospice New Zealand plead with Parliament to ensure that their voice is heard, that their experience is recognised and respected. I am putting that on the record now, asking all members to do just that—particularly with the narrowing of criteria to terminally ill people only.

The other person whose submission I particularly want to draw attention to in this regard is from Dr Kate Baddock, the chair of the New Zealand Medical Association (NZMA), who made a submission to the Justice Committee. Her organisation has continued to liaise with all of us to advocate for this very clearly. The NZMA remain passionately opposed to the passing of this bill, and it’s vitally important that we take that on board.

Thank you, Madam Chair, for the opportunity to contribute in the second part of this bill. I would like to start where Dr Nick Smith left—that it is very important that the family of the person concerned should be informed. It is very important.

I would like to touch upon my Supplementary Order Paper 309, which touches on clause 17(1). It says to amend the words “within 14 working days of a person’s death” with “as soon as practicable, but in any case no later than five working days after a person’s death”. It is very important, I think, Mr Seymour. I spent three or four days listening to the submissions in Auckland. Had that member done that, listening to the submissions, he would have changed his mind and withdrawn his member’s bill because there were so many moving submissions given. Not a single person turned up on those days who was in favour of this bill; everyone was against this bill. That would have really changed the mind of the member, I hope, if he had done the hard yards sitting on the Justice Committee. This clause where 14 working days is being mentioned—it can be up to a month because, when we are talking about 14 working days, it means 3 weeks. If it is during the Christmas period, it can be extended to a month or so. Why would they want to hold this information, to be sent to the registrar, for a month? Then there is a process after that which is to be followed.

The second thing which I am really concerned about is that I went with my colleagues the Hon Jacqui Dean and the Hon Amy Adams to visit the Netherlands to understand this bill. I was not convinced that there are clauses which can protect vulnerable people so they will not be abused with this bill. I think it is very important that we have to make sure that the people who we consider are vulnerable should not be abused and should not be given this process. We know that, particularly if we are talking about culturally, from the Indian perspective or from the ethnic perspective, it is very important. Some of the people will not understand what is happening and some of the religions—particularly, I was talking to the Muslim community; their religion doesn’t allow suicide, and this is a kind of suicide which is being promoted in this bill. They can’t understand it. There are loopholes in this bill where people will be really struggling to understand what is going to happen, because there will be reasons why the family members, or someone who has got an interest in a person’s death, and can benefit from that reason. So I think the members of this House will consider my Supplementary Order Paper in which we are replacing the words “within 14 working days of a person’s death” to “as soon as practicable, but in any case no later than five working days after a person’s death”, and will be supported by the members so that we can at least provide this protection to the person. Thank you.

Oh, thank you, Madam Chair. Look, I’m really pleased and I actually support my colleague Kanwaljit Singh Bakshi’s thoughts there. Why it takes 14 working days to do the paperwork is beyond me. In fact, you know, as others have mentioned, I think, in earlier debates: if you’re dealing with family who are not told, they are now going to be none the wiser for up to 14 working days, which could be a whole month of time.

Look, I just want to go through, if I might, some of the elements of Part 2, which, I think, for me illustrate what is effectively—and I’ve said it before and I’ll keep saying it—shoddy legislation. I encourage colleagues, with Part 2 and any part of this bill, to look at the wording and the number of pages compared to any other legislation, and we’ll find that this is incredibly lightweight. The further challenge begins to develop in Part 2 around all of the reporting—in fact, there’s more talk of reporting the actual act of killing someone—if you take all that out of it, you’re left with something quite hollow. It starts, of course, with the title of Part 2, which is “Assisted dying”—again, a euphemism; I always come back to that. I just, sort of, encourage the promotant of the bill and those that have, sort of, I don’t know, the moral courage to push this to use the right language, because doctors all the time—and hospice, who have come out very clearly today as before, and palliative care people—will tell you that they assist people to die every day. I’ve assisted people to die, but that doesn’t mean I’m injecting them with lethal injections.

Secondly, if we’re moving through Part 2, you get into clause 8—and, again, it’s a great example of sort of the shoddiness; I’d go as far as to say, sort of, almost a willing duplicity that comes through in the language. Clause 8(2)(e) sounds wonderful, and it says—this is about telling people that you want to die—“[you] encourage the person to [talk and] discuss their wish with others such as family, friends, and counsellors”. You know, people reading this, if they get to clause 8(2)(e) in Part 2, they’ll go, “Oh, it’s wonderful.” But, of course, you’ve got to read on in this bill, and it’s a classic case; it happens in multiple places. You’ve got to get to clause 8(2)(f). It says to ensure that the person knows that they don’t have to actually discuss their wishes with everyone. There’s almost, I would suggest, an interesting falsity that’s been put in by the drafters of this bill, those various lawyers who I won’t name but are known to myself and others. Why would you put the—actually, I can use “you” now, can’t I? This is actually quite liberating.

CHAIRPERSON (Hon Ruth Dyson): That’s at the discretion of the Chair.

Oh, yes, indeed; I’ll indulge the Chair.

💬 Hon Tim Macindoe: And what is her judgment?

I’m in trouble.

CHAIRPERSON (Hon Ruth Dyson): Not yet.

The positive element is put first; the one that, if you will, will calm people’s considerations is put first, followed up—and this is not the only example—by a situation where, in fact, it’s very clear that a person doesn’t have to tell their family members, loved ones, or anyone; I think that’s a real problem.

Look, moving on, because I know people have touched on coercion and conscience—and there’s a depth there. But if we go to clause 15, in Part 2—I’m going to call it the “lethal dose of drugs”; “medication” is, again, a falsity—it says in clause 15(3)(a) that the attending medical practitioner needs to advise people of the different ways the medication will be administered. I think that’s positive; it’s good to know if you’re going to be injected or ingested. I notice they haven’t followed the French model, which is around suppositories, and it’s quite effective. I don’t know that from practical experience; I just know enough things medical. But what it doesn’t say—and, again, it shows how shoddy this is—it doesn’t actually explain to the person who’s about to die what happens and that, actually, these drugs, be they ingested, intravenous, or otherwise, are going to stop the heart, cause convulsions, and what they’ll do to your body—none of that is actually put there. Again, it looks nice in clause 15(3) that they must tell them about how it’s going to be administered; it doesn’t actually say what it’s going to do to the body of the person.

We then jump to clause 16—again, it’s a further example of the problems that are just myriad throughout this, and I really encourage those members who spoke, particularly in earlier readings about the need to have a full discussion, to actually get up and take a call or perhaps listen. It says in clause 16(5) that the attending medical practitioner must be available to the person until they die; or arrange for another medical practitioner. Look, I’d say that’s a good thing—that’s a good thing—but, again, it’s so lightweight, because what we know is that this doesn’t happen instantaneously. It does for some, but some people—and there are good recorded examples—can live for days after taking these medication—days, OK? There are well recorded instances, I think, in Oregon—go and look at the evidence—of over 104 hours. Let that sink in, members: 104 hours before someone died.

Thank you, Madam Chair, for the opportunity to speak on this committee stage. I’m going to talk mostly about clause 8 and what is a very lightweight attempt to protect those from coercion.

But I’d like to start off, and it may have already been mentioned earlier, saying that a society is judged by the way it treats its most vulnerable—Nelson Mandela, Mahatma Gandhi, and others. This clause 8 just does not protect the most vulnerable, in my view. David Seymour talked about, in a previous setting a couple of days ago, how the evidence of cohesion cannot be found anywhere where assisted dying has been legalised. Now, I’ve never heard such nonsense as that sentence. It is just obviously wrong to say coercion does not exist. We know coercion exists. We do it here all day, every day; that’s what our job is. We are here to influence. We are here to coerce. We are here to compel. We’re trying to convince each other that our policies are right and the others’ are not so right. In the schoolyards, kids are coercing, bullying, and hassling each other every day. Every day in the workplace it happens. Coercion is alive and well in our communities. In Parliament, coercion happens on a regular basis. We’ve had reviews about the bloody subject. It’s ridiculous that David Seymour has somehow decided that there is no evidence of coercion, because he doesn’t want to see it, he doesn’t understand it—at best that is naive. Coercion is alive and well.

In fact, the worst place that we can see coercion is in our own homes. In some of our homes in New Zealand, coercion is at its best. We have partner abuse, we have child abuse, and we have sexual abuse in our own homes. And then to say that there is no such thing because we can’t see it is naive and unfortunate.

We talk about elder abuse—that’s known; we wear ribbons to acknowledge elder abuse. We’re not talking about killing them; we’re talking about stealing their money, whacking them around the head if they don’t take their medicine, you know, keeping them up late at night, not putting them to bed when they should be, not wiping their butts when they need it—that is elder abuse, that’s the minimum side. And here we are today, really wanting to go hard with the elder abuse by allowing, sometimes, family members to coerce those elderly people to kill themselves. This lightweight protection in clause 8 does nothing—nothing at all—to protect those who are our most vulnerable.

I’ve had constituents ring and email, and I’m sure we have all had these examples where we’ve had people say, “Euthanasia is a good thing. Grandma’s on her last legs. We’ve been visiting every week or every day. She wants the easy way out. She wants to go now.” I don’t get the email from Grandma. No grandma has ever emailed me to say that; it’s the family that have said that. You’ve got to ask yourself what is motivating these people to suggest that Grandma wants to leave this place ahead of time. It’s in their own self-interests that they want Grandma to leave ahead of time. It is because they don’t want to see Grandma old, elderly, having to have her butt wiped, and sleeping for most of the day. They don’t want to see that, because that’s not what they’re used to seeing Grandma as. But Grandma has never asked me to support this bill; it’s only ever been families of elderly people who think that it’s required for the dignity of Grandma. But, in fact, it’s for their own self-pitying, self-centred, self-interest that they want Grandma out of here early.

Thank you, Madam Chair. It’s a great pleasure to rise in opposition to this bill. In this time that I have, I would like to commend the speech that was given by the Hon Dr Nick Smith in relation to clause 8, and I’d like to, sort of, address subclause (2) of that clause, which talks about the “attending medical practitioners must”—in paragraph (h)—“do their [very] best to ensure that the person expresses their wish free from pressure from any other person by—(i) conferring with other health practitioners who are in regular contact with the person; and (ii) conferring with members of the person’s family approved by the person”.

I am particularly interested in talking about that section, but before I get to that, I’d like to talk about what the member—the sponsor of this bill, who is actually sitting in the chair, made a comment before dinner break, mentioning that I had, in fact, said that I represent all of Koreans. I don’t think I ever actually said that during the first part of this bill. I don’t think anyone in this House represents all of the people that they’re talking about. What I did actually say was that I did do a poll, and I talked to the Korean community, and the majority of the view was their concern for this bill, and I wish the member would actually quote me correctly when he speaks as if he is speaking on my behalf.

I did also quote in the first part—and it’s related to clause 8, which is about coercion. One of the examples that I actually gave in that part was about a person in the Mt Albert electorate who has a father who has dementia, whose mother has actually had a very bad health situation, and she has been stealing from her parents—her elderly parents. I mentioned about my fear should that person—that daughter was this particular family member who the doctors will be conferring with to get the approval. If the mother was in hospital, having been diagnosed with cancer—which she had been—and if she had gone to the doctors with this particular daughter who drove her to the doctors, and the doctors were looking at the mother and saying, “Do you agree that this daughter can speak on your behalf?”, the mother would never, ever be able to say, “No, I do not.”

What happens if that mother is being abused, like some of my learned colleagues have said, at home—in their home? If the mother or the father had been abused, there are plenty of examples of elder abuse in this country. I think it is Age Concern who said that approximately three-quarters of all such cases involve abuse in the family. Three-quarters of such cases also involve financial fraud, and illegal control of the assets owned by the elderly parents. Often, as one of my members earlier had said, do these family members have, you know, certain intentions when they’re speaking on their parents’ behalf; when they said, “No. My parent, my grandmother, wants to die.”?

I would like this particular medical practitioner to have more experience, more involvement with the patient, because I don’t think they can ever be a judge, when they’re deciding when this patient wants to kill themselves, that they did not have coercion. I know earlier, David Seymour had said—I think in Part 1, he actually said—that there was never any proof of coercion in the history of euthanasia. Can I actually quote, what about the disabled Canadian Roger Foley, who was offered medically assisted death in place of assisted home care—he is now taking the Government of Canada to court. There was coercion. There is proof of coercion that is going through the courts, and David Seymour knows this very well. For him to say that there’s never been any coercion in the history of euthanasia—he is absolutely not telling the whole truth.

Thank you, Madam Chair. I didn’t expect to get that call that quickly. I’m well on record with my opinion of this bill, but I just wanted to say something about the time it’s taken to get this piece of legislation to this point, and I guess that as you think about these things, you could see there could be reason for a positive view of euthanasia, if it were in a form where there were sufficient safeguards. However, the number of Supplementary Order Papers, and the way this bill has been put together, concerns me, and I think there are chances—certainly very strong chances—that unforeseen loopholes in this legislation are likely to appear.

I want to spend a bit of time on clause 8, like some of my prior speakers have. But some of the issues I want to raise are a little different, and they do relate to some extent to the potential for coercion. But I oppose this piece of legislation because I’ve seen nothing in the mass of changes that in any way satisfies my concerns about the potential for things to go wrong in the course of the process. There are two particular sectors of the community that I’d like to comment on. One is the disability sector; the other, of course, the elder community—I certainly belong to that.

But the first, the disability sector—I have a significant amount of experience in that, as I’ve been the chairman of Special Olympics New Zealand for the last nine years. That organisation deals with people with an intellectual disability who wish to play sport, and there are 6,000 or 7,000 participants at the moment. The issue I want to raise, though, is that one of the challenges we have in Special Olympics is identifying a person who qualifies to participate in those sports because of their disability. The challenge we’ve got in this piece of legislation is, in fact, identifying those people who have a disability, as opposed to those people who have a terminal condition. I think, I suppose, a modern terminology for that would be a brightline test. There doesn’t appear to be any way of differentiating between the two, and I think that’s a major concern.

People with a disability are under very similar pressure, often, to people with a terminal illness. I don’t think that, in my experience, very many of them would ever want to get to this point, and how they get there is the next issue I want to touch on, because I think being able to go to a doctor and get permission, I guess—or not permission, but to enter the process with a single doctor, who doesn’t necessarily know you very well, and go through that process, I think is highly dangerous. I think the other thing that concerns me about that is that there is no need—and it’s been raised by Nick Smith earlier on—for that person to go back to the family of the person concerned. I think that’s hugely concerning.

I think the other issue that affects our older people is—there’s a number of things that affect older people, but loneliness, fragility, and the fact that they may feel unwanted certainly affects a lot of our older people in our community, and the challenges they face with their families are sometimes significant. But none the less, many of them, if they had a family who cared for them, would most certainly expect that family to participate in these decisions. I think that’s really important. I just think that there are too many holes in clause 8 of this legislation for me to in any way feel comfortable supporting it. The older members of our community—you see so many tragic things going on with older people. It’s caused, as I said a little earlier, by loneliness, by fragility, by the fact that they feel unwanted, and the fact that they often get to the point where they feel that they’re no longer any use to our community or to their families, and that, I think, is also a very dangerous position to get to. It’s a very sad position to get to, but it’s a dangerous position to get to, and I don’t think they necessarily would want to be euthanised as a result of that.

I just want to very briefly comment on clause 9, where I think there are just so many loopholes in the way that you can choose, or the way that the person who gives evidence is chosen or is able to complete that evidence. I think that that is quite dangerous as well, and so people who are beneficiaries of that person’s estate, beneficiaries of that person’s life, could very easily find their way in as—[Time expired]

Thank you, Madam Chair. It’s a pleasure to speak to the bill here tonight, and I want to speak to Part 2 of the bill and address Supplementary Order Paper (SOP) 210, and, across some of the contributions I hope to make tonight, I want to offer some perspectives—my own personal observations around medical practitioner involvement. What I say here tonight is in the context, I think, by necessity, of a required higher standard of medicine, a higher standard of scrutiny than usual, because this activity is rare, it’s untested in New Zealand, and the desired outcome is very definitely definitive and intended to be irreversible. So I think across everything I’m going to say tonight, I set it in that context.

Now, this SOP is in name of Simeon Brown. It talks to prescribing the lethal medication and it talks to notifying or advising the intended recipient of what some of the side effects of that medication might be. Now, informed consent is clearly important. It’s a requirement for all health interventions, not just the notification of side effects. Medication consequences and side effects are actually codified—or the requirement to notify patients of side effects is codified—under the Health and Disability Commissioner’s code of patient rights: Right 6(1)(b) and Right 7(1). Right 6(1)(b)—again we’re focusing just on the requirement to tell patients of the side effects of proposed medications—says every consumer has the right to “an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option;”, and Right 7(1) talks about the consumer’s right to make an informed choice and give informed consent: “Services may be provided to a consumer only if that consumer makes an informed [consent]”.

Now, I want to draw on a representative case where a medical practitioner—it is representative of many, but a medical practitioner was taken to task by the Health and Disability Commissioner for not advising the patient of the side effects of medication they prescribed, and that representative example is case number 14HDC01100. In this situation, the prescribing doctor prescribed fentanyl for pain relief to a patient and the patient suffered dizziness, nausea, and vomiting, and they were not side effects that the practitioner had advised the patient of. The practitioner was taken to the Health and Disability Commissioner. He found against them in that case that I’m just elucidating.

Can I also introduce an interesting part of Australian legislation from the Northern Territory, clause 89, where they actually require a practitioner to advise the patients and family of the side effects of the lethal medication they may be administering so that they can make a decision as to whether they want to be there at the time. It reads, “Where the doctor is to assist the patient by administering lethal drugs, the doctor should provide … the effects of those drugs to the patient’s friends and family members so that they may decide to be present at the death [or not].” Well, goodness, if we’re going to tell the family and friends, surely we’re going to tell the patient what the proposed side effects would be.

So I think when we’re advising side effects, this should definitely be a requirement for several reasons. First of all, it’s a standard care with all medication, so we’re not doing anything different than we do with standard medications, but these are different—these should surely be required because they are much stronger and, by definition, they are lethal. It’s embodied in the code of patient rights, and prescribers face consequences for non-adherence. I think the consequences of these medications we’re talking about warrant special mention, and I think they specifically should be set aside in legislative commentary, which is the nature of this is SOP.

Can I also conclude by saying that I think to follow a minimum of standard practice, let alone what should be an escalated practice in this situation, somewhat creates the narrative of “Why bother? They’re going to die anyway.” And I have to say that view must never be at the death side, and most surely it must never advance its way from the death bed and further into society. Thank you, Madam Chair.

Tēnā koe, Madam Chair. Tēnā koutou katoa. Thank you very much for the opportunity to speak specifically to Supplementary Order Paper (SOP) 260 in the name of the Hon Dr Nick Smith, and I do so within the context of a definition of “informed consent”—that is, capacity or ability to make the decision. The medical provider must disclose information on the treatment or, in this case, the options for end of life choice, comprehension of the relevant information, and voluntarily grant consent without coercion or duress. I actually think the way the bill is worded in clause 8 is to ensure there is no coercion or duress, and many people have spoken tonight about elder abuse in New Zealand, so let’s talk about elder abuse.

I’ve just looked at the SuperSeniors website, and these are the facts: 2,200 reported cases. We’re estimating that actually it’s probably more 8,800—79 percent psychological, 54 percent financial, 19 percent physical, 17 percent neglect, 1 percent sexual abuse, and therein begs the question: who is perpetrating this abuse on our elders? It is 76 percent family members, 16 percent partner, 44 percent child or child’s partner, 20 percent friend or neighbour. The way that clause 8 is worded—and it’s interesting because there’s a distinction between “ensure” and, obviously, “encourage”, and the medical practitioner in most of them has to “ensure”. They have to ensure the person understands their options for end of life choice. They have to ensure that the person knows that they can decide at any time before the administration not to receive it. They have to ensure that they are not obliged to discuss their wish with anyone, and they have to ensure that the person has had the opportunity to discuss their wish with those whom they choose.

Therein lies the distinction between what Dr Smith is actually encouraging. He wants to ensure that people have to talk to their partner, parents, or children. The actual wording in the SOP from David Seymour says “encourage”, and by definition, “encourage” means to give support, to give confidence or hope to, to persuade by giving support and advice. So, actually, everything we’ve talked about tonight about the coercion, the duress, elder abuse, all that type of thing—the proposition in Dr Smith’s SOP is that we would encourage that elder abuse. I have to say, someone who is facing an end of life choice decision will talk to the people that they trust. They will talk to the people that they know love them and support them and will support them through this incredible decision.

The average age, or the median age, of death in Oregon is 72 years. So the context of elder abuse is incredibly important, and so I want to acknowledge everything that people have said tonight. But the difference between “ensure” and “encourage” is huge—absolutely. And so under Dr Smith’s proposition, someone who wanted to choose end of life choice may have to, as espoused in the statistics, consult with family members who have abused them. If that’s the intention of Dr Smith’s SOP, it’s actually incredibly—everything that everyone’s said tonight actually reinforces why it should be “encourage” not “ensure”, because what you’re ensuring is that family members who abuse their elderly family members are going to be involved in a decision that that person has obviously chosen for them not to be involved in, and I think everybody in the Chamber tonight who has talked about elder abuse actually has to think about the logistics of what Dr Smith’s SOP is actually saying.

The other context—with my 39 seconds, just in case I don’t have another opportunity to speak—was actually also against SOP 302, Chris Penk’s, because at the heart of it what we’re talking about are people who have consented previously. This provides a medical practitioner—a medical practitioner who thinks that the person who may have consented earlier, actually, under this proposition, has to go through an independent panel of practitioners to determine whether pressure was present. That’s all about informed consent that we’ve talked about earlier, and that’s just another layer of bureaucracy that actually is just a barrier.

Thank you, Madam Chair. I would like to speak to Supplementary Order Paper (SOP) 295, in the name of Michael Woodhouse, which has not been debated as much in the last period that I’ve been following the debate. Mr Woodhouse and I run in the same seat in Dunedin, and there are often things we disagree on. This is one of those occasions where I agree with Mr Woodhouse and the SOP that he has put forward. I want to acknowledge the thoughtfulness of the SOP and encourage members from both sides of the debate to consider its merits. It’s an SOP that is designed to create an exemption for organisations that have a conscientious objection to assisted dying. I think it’s quite a constructive SOP. It’s not designed to stop the passage of the bill. It’s not designed to stop the effect of the bill should those people who are proponents of it have their way. My concern—previously brought to the fore in this debate—is around those who are most vulnerable, and I just want acknowledge that overseas examples that have been brought to my attention suggest that those who are of lower socio-economic status or marginalised in society are those who are most likely to end up having assisted dying or euthanasia, and my concern is around the vulnerability of those people.

This Supplementary Order Paper doesn’t entirely get to that issue, although there may be some overlap. What it does is it proposes—it’s Supplementary Order Paper 295—that there be an exemption for conscientious objection by an organisation. That could be a faith-based organisation or another type of organisation involved in providing care in the community, perhaps in the area of physical or intellectual disability. It might be palliative care. It might be aged residential care or hospice care.

The effect of the SOP is to ensure that no department, Crown entity, or other public sector entity responsible for funding, commissioning, purchasing, or procuring services may make a discriminatory decision on the basis of a conscientious objection by an organisation. That includes funding decisions, so that a hospice that wishes to ensure that euthanasia is not practised on its grounds is not in any way discriminated against in a funding decision, and so that services can continue to be provided into the community that are clearly free from those influences.

Now, why I think this is a worthy amendment, particularly, is because it’s not trying to scream from the hilltops here; it’s trying to create a compassionate carve-out for those who would think differently on the issue—and recognising that in this debate the members of Parliament across the House are thoughtful on both sides of the House. There are a lot of people who are both for this and against this, and I believe on good conscience on both sides—people who have personal experiences that have formed their views both for and against assisted dying.

For those who would wish to attend an organisation that is very clear that it does not want to have to do with assisted dying, for faith reasons or for other reasons, it seems reasonable that they should be able to attend those organisations, that they should continue to be provided in the community. Particularly, where the language of “choice” is used by the proponents of this bill, this is another kind of choice. This is a choice people might want to make to go to a place where they feel safe in their final years of life, or moments, or whatever it may happen to be.

For those who oppose the bill, many I have heard—or some, perhaps—are voting against all amendments. I would say this is an amendment for those who oppose the bill, who, even though they may not like what comes out the other end—if the early indications are anything to go by—might see a way that some of their concerns may be tempered through the provision of services deliberately to the public for those who wish to avoid being in an organisation that practises euthanasia.

It does get to one of my concerns around vulnerability, particularly with the disabled community and so on, because I do believe there will be organisations who will make a point of saying that they will not have these practices on their premises, and that will give some parents and friends and family the comfort of knowing that they can refer somebody to a service where this will not be something they need to be concerned about. I commend SOP 295 to the House.

Thank you, Madam Chair. I want to engage in the debate and the challenge that was made by Louisa Wall with respect to my Supplementary Order Paper 260 on the issue of the involvement of immediate family. The bit I agree with is that there is a world of difference between the words “encourage” and “ensure”.

“Encourage” is a weasel word. Let’s be honest: when we are legislators and we say that something should be encouraged, the final test of the law is a court, and in a court of law, whether you encouraged or didn’t encourage has got a gap that’s a lot wider than a bus. There is no real legal enforcement. That is why I argue very strongly that the word “ensure” says that immediate family—children, partner, husband, wife, and parent—should not be excluded from a life-and-death decision such as the assisted suicide that’s provided for in this bill.

Now, the member argues that there’s a small number of cases—a case that causes great concern for opponents of this bill—around the issue of elder abuse. But here’s my test for the member: even if there is a case of a son or daughter that is guilty of elder abuse and they’re involved in the process of the decision of someone who’s wanting to get assisted dying—assisted suicide—the worst that they can do is to persuade them to be living—right? That’s the worst. Wouldn’t that be an awful thing? Wouldn’t it be an awful thing for a son or daughter to say to their mum or dad, “I love you to bits. I need you around. You add strength and value to my life.”—right?

💬 Louisa Wall: What a spin.

Well, what I’m saying to the member is: shouldn’t we as parliamentarians be erring on the side of life? That is the value judgment where I see the world very, very differently to the member opposite and their view.

A decision for assisted suicide is not a decision that can be reversed. It’s not a decision that you can say, “Oh, I made a mistake. I want to undo it.” I just think there is an ignorance from members about the importance of family.

💬 Hon Stuart Nash: Look in the mirror before you start calling people that.

I say to Stuart Nash: the importance of family to society and the capacity for someone to take their own life and for their son or daughter, their husband or wife, or their mother or father to not even know about it until after the event actually is obscene. It is obscene.

What the member is arguing for is that somehow in society the relationships that we have with people like our lawful husband, wife, or partner, or whether it be our mother or father—do not those people have rights too? Aren’t they an important check to make sure that the person who’s making such a decision actually understands the implications for others and the effect on family? Haven’t people felt the pain that goes with suicide when somebody takes their own life, and with the failure to even be able to have those last conversations with that loved one that are just so important for life? Don’t members get the importance of those relationships? Why are they considering a bill that would cut out the sons, the daughters, the husbands, the wives, and the mothers and fathers from a decision such as this?

I look at the laws that exist in other jurisdictions; they are substantially stronger in this area. I want to hear the argument as to why those immediate family members—why is it that this bill includes greater rights for medical professionals to be informed than for the loved ones of someone that is considering assisted dying?

Well, thank you very much, Madam Chair. I thought it was perhaps a good time just to take a call and address some of the concerns that members of the committee have raised, starting with Paulo Garcia, who was the first speaker after the dinner break. He brought out what I regard as the old chestnut of undetectable coercion. It always reminds me of a question I was once asked at an airport in London: “Has anyone put anything in your bag without your knowledge?” I paused for a moment and I thought: how do I answer this?

Look, I think, if there was undetectable coercion, it would show up in the data. It would show up in the data in an unmistakable way, and that would be that the people whose lives were ended through assisted dying would be more often than not people who were vulnerable to coercion. They would be people who had less assertive personality traits, people who had less education, and people who were of lower socio-economic status, and yet after extensive studies—as long as 15 years of studies in the Netherlands—what we’ve discovered is that, actually, it’s not people who are more vulnerable who end their lives through assisted dying; it is the opposite. That pattern, if there was so-called undetectable coercion, it would show up in the data, and it does not show up in the data. That is the fact.

I want to turn to what Dr Nick Smith has said. I think, really, he’s misconceived what the bill says, and I draw members’ attention to clause 8(2)(e), which says “encourage the person to discuss their wish with others such as family, friends, and counsellors;”. Now, Dr Smith has said that family are excluded under this bill. Well, they can’t be encouraged to talk with family and exclude family at the same time. Logically, it has to be one or the other.

Dr Smith would like to say that, of course, it should be mandatory for family to be consulted, but if he was serious about that, then perhaps what should happen—

💬 Hon Dr Nick Smith: Immediate family—immediate family.

“Immediate family”, Dr Smith clarifies. If Dr Smith is sincere about that, then why not have that for all medical procedures? The answer is simple, and that is it is people’s privacy. It would cut across people’s privacy to force people to have to talk to family members.

What’s more, as has been eloquently outlined by Louisa Wall, it’s not necessarily a good thing in every family. Families are complicated, as Maryan Street has often said in debates about this topic. I think it would be counter-productive to adopt Dr Smith’s argument for those reasons.

I must say, Kanwal Bakshi said that I should do the hard yards on this bill. People have accused me of a lot of things, but not of failing to do the hard yards on this bill. I do note that Mr Bakshi had tabled a Supplementary Order Paper (SOP) only hours before the debate, so people can make up their own minds about who’s doing the hard yards.

There were a number of people—well, there was Alastair Scott. There was David Clark, who talked about the Michael Woodhouse SOP, and I think for the benefit of Dr David Clark in particular, it’s worth addressing the concerns that he has raised. I say to him first and foremost, as I mentioned earlier, I was a little bit surprised when he said that people of lower socio-economic status were more likely to access assisted dying in jurisdictions where it’s been legalised. That is untrue, and there’s been fairly extensive studies over up to 15 years in places like the Netherlands, where, actually, the opposite has been found to be true. So I was a little bit concerned that the Minister of Health took that view.

But turning to the Michael Woodhouse amendment, in my view, first of all, it is unnecessary for the simple reason that it’s not clear why you would want to exempt institutions from obligations they don’t have. There is nothing that institutions are obligated to do in this bill, so it seems strange to exempt them.

Second of all, there are other parts of the particular amendment such as restrictions upon funding, which make it, effectively, illegal for a district health board (DHB) to enter into a contract with any provider of any kind of palliative care where they did want to provide assisted dying. Now, I’m sure Dr Clark, as a good southern social democrat of Presbyterian stock, would want public funds to be able to be used for things that are legal according to this Parliament. If he believes in comprehensive public health insurance and if he accepts the findings of this Parliament that it wishes to make assisted dying legal, then it would seem strange to ban public funding of a legal service that some New Zealanders would be able to afford to access privately but others might not, and I think for that reason alone the amendment should be defeated. It actually prevents public provision of the service.

I say to those on my right that it might seem strange that I would say that. Well, my view is that if somebody wants to go and require taxpayer funding, then they’ve entered into politics. They have entered into a contest in a political discussion about what conditions should be attached to the use of public money, and it’s quite reasonable that among DHBs and institutions there would be such a discussion about what will be provided and what will be funded.

That doesn’t necessarily violate anybody’s rights, and it might give some comfort to Dr Clark to know that these debates have been played out in the Australian state of Western Australia—which has recently had the second reading of its bill that is similar to this one—in the Australian state of Victoria, in the country of Canada, and also, before that, in the province of Quebec. In all of those jurisdictions, there has not been a carve-out of the type that is proposed here in the final legislation, although it was discussed in all of them, with the one exception being Quebec. In Quebec, they actually went the other way and required that public institutions would have to offer assisted dying—which I am opposed to—and the reason they had a carve-out was against that more onerous public requirement, which, as I said in the opening, we don’t have in this piece of legislation.

So look, I really hope that that allays some of the concerns that Dr Clark raised, because he does deserve an answer there. I hope I’ve given him a good one.

We heard from Dr Shane Reti, who I have to say has a beautifully pressed shirt and a very well-chosen tie. But besides that, as I was listening to him, I was thinking that he was asking for things that are in the Code of Health and Disability Services Consumers’ Rights to be put into the bill. Now, if it was the case that there were provisions in the bill that contradicted the code and, of course, in that case the statute law would prevail over the code, then it would be necessary to clarify that, actually, people still have those rights in the code to be given proper informed consent over the medication that they’re taking. But in actual fact, there’s no such contradiction, so everybody is still expected to follow the code and give proper informed consent to all patients.

Indeed, if you go to clause 15, there is considerable requirement from the statute law as well that the doctors have a discussion about the type of medication that is taken and the methods, and of course that involves the impacts. Any doctor doing their job, as Dr Reti would well know, would do that, so I don’t think it’s necessary to amend the statute law to achieve that.

We also had Louisa Wall, who I thought gave a very good refutation of some of the points raised by Dr Smith.

We also had Melissa Lee, who challenged my word in the House that I’d somehow misrepresented what she’d said in an earlier debate. I checked the Hansard and I was right: she did indeed characterise the views of all Korean people, and that’s something that I think, frankly, members should try and stay away from. We should treat every person as an individual and judge them on their personal characteristics, rather than stereotypes, but that’s just my view.

Aside from that, we heard from Ian McKelvie. Ian McKelvie is somebody who I have a great deal of respect for, and I want to address one concern in particular that he raised, which was in regard to the process. Mr McKelvie’s been here a lot longer than I have—in fact, he’s been in a lot of places longer than I have—and I have to say to him that there’s never been a longer process, a larger select committee consultation, or more work gone into a member’s bill. I suspect it would be a very long time—longer than both of us have been here put together—so I do think that criticism is unreasonable. The other questions that Ian McKelvie raised around coercion and self-interest and so on, I’ve addressed in response to other speakers—hopefully, to his satisfaction.

So that’s all from me. I hope I’ve answered the concerns that have been raised adequately. I know there are some people I may never be able to satisfy, but, as they say, God loves a trier, and I’ll keep trying.

I move, That the question be now put.

I raise a point of order, Madam Chairperson. I know you haven’t made a call on that, but I have got a number of Supplementary Order Papers—

Have you got a point of order, Simeon Brown? Do you have a point of order? Can I just advise the committee that we have had over two hours of debate. There are only 12 clauses in this part. Every member who has lodged a Supplementary Order Paper (SOP) has spoken to it, with the exception of the Hon Michael Woodhouse, and, fortunately, the Hon Tim Macindoe and the Hon Dr David Clark and others have addressed his SOP because he is unable to be partaking in the debate. There has been a huge amount of repetition. If we continue the debate, it would be advantageous if we could have genuine questions to the member responsible for the bill, or new material.

I raise a point of order, Madam Chairperson. I do raise a point of order in respect of Speaker’s ruling 61/4. I’ve long felt there is a really unsatisfactory aspect relating to closure motions, and that is that there is no opportunity to explore the reasons why they might have been accepted—and, of course, that completely shuts things down. So, in fact, I’d like to raise both Speakers ruling 61/2 and—

CHAIRPERSON (Hon Ruth Dyson): Sorry to interrupt. Have you got a point of order?

Yes. Under Speaker’s ruling 61/4 and—

CHAIRPERSON (Hon Ruth Dyson): Do you have a point of order?

I’m raising a point of order with you under Speaker’s ruling 61/4 in Speakers’ Rulings, and Speakers’ ruling 61/2, and the point I want to make is to draw your attention to the fact that in this particular debate, there are a huge number of amendments that are being put. Yes, there has been a significant body of debate already, but a number of SOPs have not yet been debated. A number of those members—

Sorry, if the member could resume his seat. I haven’t ruled that the debate is closed—

💬 Hon Tim Macindoe: No, no—

CHAIRPERSON (Hon Ruth Dyson): I haven’t ruled that the debate is closed. Acceptance of a closure motion then leaves it in the hands of the committee to decide whether the debate has concluded. My only role is to put the motion, and I haven’t. So if the member would like to read further on that page, I think it would be to his advantage.

Thank you very much, Madam Chair. I’m pleased that this is continuing. I will add a comment that it’s been striking, as it was in the first part, that those who have never taken a call but have spoken about the importance of this are trying to shut it down. There are a number of clauses here, and I will continue talking to clause 16, which has not actually been fully discussed; nor clause 18, which I will get to. It does need to be noted, though, that the member in the chair, David Seymour, who’s responded, has certainly noted the ties that members are wearing and the nature of ironing quality but has not actually addressed the questions.

When we look at this whole part, the first thing that needs to be noted is that the choice is not with the person; that’s been raised several times. This is an entire process about doctors choosing. I would note in clause 8(2)(b)—which has not been discussed—whether the member in the chair has given any thought to the Harmful Digital Communications Act, Principle 9, which says that one is not to use harmful digital communications to facilitate a person to commit suicide. I’d note in section 8(2)(b), which has not been discussed hitherto, that the doctor may actually—sorry, it’s not even a doctor these days; is a health practitioner. Watch out podiatrists! I note that you may use a telephone or social media to talk to the person. I, by nature, would define that as a harmful digital communication, which offends Principle 9, and I would expect the member in the chair to try and answer that one.

I was interrupted earlier, as I had taken only the one call on clause 16(5)—that the medical practitioner must be available. As I noted, in the likes of Oregon, people have survived up to 104 hours, and I’d really like to know how the member—again, with this shoddy drafting—is imagining that a doctor is going to be there for that length of time. How are they going to take rest breaks and meal breaks and so forth? That hasn’t been discussed.

As well, we know from the overseas data—and unlike the people who are supporting this bill, I am more than happy to table all that evidence, and have done many a time—that, actually, in the Netherlands, in 16 percent of assisted suicides—so that’s when you decide to kill yourself—and 6 percent of those who seek euthanasia, which is far more efficient because the doctors are doing it, there are complications. This bill is, effectively, silent about what the attending medical practitioner as outlined in clause 16 is meant to do. So not only have we a situation where people are surviving much, much longer—because the general view in people is that this death with dignity is just nice and easy, the doctor walks in, anaesthetises you, muscle relaxants—because, as I’ve mentioned before, you don’t want to fight back—and then terminates you. But, as we know, two things can happen—not in all cases; I want to stress that we are talking exceptions here—

💬 Marja Lubeck: Repetitive.

Sorry? I heard a muttering from someone who might choose to take a call, which would be novel. That might have been one of those unwanted complications! Hours to die, and there is no structure here for the attending medical practitioner, according to clause 16(5), of how that is to operate. Yes, I notice in 16(5)(b) it says to “arrange for another medical practitioner …”. But if you’re up to 104 hours—which is days, by the way, for those mathematically challenged—how does that look 24 hours a day?

Now, the member in the chair might point me—might point me, because, you know, he’s novel—to 16(6) and say that that person has to be available. As I pointed out in my earlier contribution, it always starts with the positive: that the doctor, the medical practitioner, has to be in the same room. And you go, “Gosh, that’s lovely.” And then you read 16(6)(b) and it says, well, “not in the same room … but is in close proximity”. Well, that’s fascinating because, once again—because this is shoddy drafting—what does that mean? Close proximity? Is that, if we go back to clause 8, that your Skype is running, that you’ve got FaceTime? What does that even mean? So the challenge to the member in the chair is—and particularly those who support this, who don’t seem to take calls, strangely—what does that mean? Even if you support this legislation—and every member has the right to—what does that mean for the patients like those in Oregon who take 104 hours to die? Is the doctor in the room, in the room next door, somewhere in the hospital, down the road? Where’s the specificity? And we somehow, as a Parliament in this debate, are looking to sign this off without the specificity as is required.

I’d also note, if we move on to clause 17—[Time expired]

I stand to rise, and I do want to introduce a new conversation and debate on a part that hasn’t been debated, and that is in clause 11. Clause 11 talks about a second opinion to be given by an independent medical practitioner. Where this becomes important is that I would like to ask the member in the chair, David Seymour, because he states quite clearly and has debated in this committee and in the Hansard that part of the safety mechanism is that there will be two medical practitioners. But, as I read this, I want to question that, and I’d like the member in the chair to actually respond to it, because, in clause 8, it actually talks about the request that is made—8(h) talks and it requires this: “do their best to ensure that the person expresses their wish free from pressure from any other person”. So that’s the point of coercion. That’s been the conversation and the debate that we’ve had in the committee. We all accept that; we understand that. But the member did say in this Chamber and on record that there were going to be two medical practitioners. But what it cites is the fact that both medical practitioners will then identify whether there has been coercion.

As I read this, all it asks for the second medical opinion from that practitioner is just to decide whether that person is eligible for euthanasia, for assisted dying. That doesn’t actually say that they have to also too ensure that they are what you call free from coercion, free from any pressure. I think that’s significant. I think that’s important, because the member has consistently said he’s had a double safeguard in place. That is not how I read this clause inside the bill. I’d like the member to be able to answer that question. He’s often talked about, the member, the duty of care we should be taking. But I’d like to remind the member, and, in fact, just recently he actually, in his comments, quoted about the extensive submissions—in fact, nearly 39,000 submissions. In fact, it was a quote with Ian McKelvie, and it was in regards to the amount of time that he’d spent. What he doesn’t quote inside of that is that 91 percent—in fact, 91.4 percent—opposed the bill.

Let’s talk about the health practitioners, because he has often talked about the health practitioners. This clause talks about the medical practitioners. Madam Chair, 93.5 percent of those who gave an opinion on this bill, and in particular that which would relate to this clause, oppose the bill. So the member can stand up in the committee. He can try and convince us that this has the support of those that are out there, but already we’ve seen that there is a huge support for those who oppose this bill.

The member also talked about the fact, and in his comments, of there being no evidence. I’d like the member to also stand up and quote from the research that shows there is no evidence, because we can quote from research that there is evidence of coercion. There is evidence of the fact that there has been non-consent for those—and we’ll take the Belgian study, for instance, as an example. In that Belgian study, it recorded that of those that were surveyed, nearly 32 percent of those were non-consent. Now, the member can shake his head, but I’d like for him to quote his surveys, his reports. He hasn’t been able to do that, inside this House. This relates to this aspect of this part of clause 11, and it relates to the duty of care. Again, I keep coming to this House—and I want to reiterate that we have said in the second reading, many members have said, let it do due justice. Let’s have due diligence to allow us to debate in this House.

This has had the largest number of submissions. I want to read from one of those submissions, because people took the time to not only have a written submission but oral submissions were submitted—the largest number of any other bill in the 165 years of this Parliament. I believe it deserves the debate and the time that should be given—more than just a couple of hours—to debating this bill. Here’s what one of the general practitioners of many had to say: “I am greatly concerned how the legislation of euthanasia will impact doctors and other health professionals across the country. The great majority of New Zealand doctors are opposed to this bill.” A number of them have also said that they are not trained to detect coercion. QCs and lawyers have said the same thing, so how can we be sure—how can this bill be safe? This is the challenge to the members on the other side.

For those who are questioning about whether we should support this bill, we all have a duty of care to ensure that we do no harm. If you believe that the safeguards are not in place, then you should oppose this bill. You should oppose the changes and amendments that are there, because they do not provide what I believe, and what 39,000—93 percent of those health practitioners—believe. This bill will do harm to those who are vulnerable in our communities.

Thank you, Madam Chair. It’s a pleasure to take a call in what has been a largely respectful debate throughout the numerous stages of this. I do just want to highlight that, because of the particularly serious nature of this proposed legislation, people have very strong opinions one way or the other, and I appreciate that there has been a range of views expressed and canvassed here. Now, I have supported this bill to date, and fundamentally I believe that there is a place for this legislation. I’ve also, from the start, expressed my concerns around the risks of coercion and how in fact you can have confidence around a diagnosis of a terminal illness. So those are the couple of aspects that I just want to touch on with this contribution.

I’d like to start with the debate under clause 8 around the involvement or not of family members in this decision-making process, noting Dr Smith’s Supplementary Order Paper (SOP) suggesting that direct family members should be consulted as a requirement, as opposed to simply encouraging the applicant, as it were, to consult with them. I also note Louisa Wall’s comments in relation to that around the risk of elder abuse or coercion. Now, my personal perspective on this is that there is a risk that by requiring someone to consult with family, those family members are more likely to be ones who may, if there is any elder abuse, be the perpetrators of that. Indeed, immediate family members are more likely to be benefactors of the outcome of an inheritance, for example, which could even independently, or subconsciously, rather, influence their decision or input into that debate. So that’s a very serious concern.

On the other hand, I absolutely agree that family is the most important social construct in our society, and the thought that someone would not consult with their family on this is very concerning for me as well. This one really highlights to me the complexity of what we’re trying to do here, and neither of those scenarios are particularly palatable to me, because family, personally, is hugely important, and yet the risk of coercion always is there as well. So it highlights that complexity of how we actually navigate a potential solution in this legislation—can that actually be achieved or not?

The other aspect that I want to touch on is around the practitioners, the medical practitioners. Look, I have absolute confidence that medical practitioners involved in this would be very aware of the implications and the seriousness of what they are doing and would typically err on the side of caution. If there was any uncertainty or any doubt in their mind, I would expect, through their professionalism and their roles, that they would make an appropriate decision. So whilst I note some of the concern, I feel that we need to have trust and confidence in our medical practitioners that they can indeed make appropriate decisions.

Having said, that my concern around clause 10(2)(c) is that because of the seriousness of this legislation, we may well see scenarios where the attending medical practitioner might suggest “Yes, this person is eligible, but actually I don’t want to be the one making that decision. I don’t want to take that risk on board myself. I’ll kick it up the chain to the psychiatrist.”, therefore shifting that responsibility. Again, the second—the independent medical practitioner could indeed do the same under clause 11(3)(c)(iii). So the risk there then is that the decision for eligibility or not is shifted from two people to a single person, being, as I say, a psychiatrist. That was the reason why I actually supported the SOP put forward by Agnes Loheni in Part 1, requiring a minimum of five years’ experience for that psychiatrist, because, to me, that puts a significant amount of pressure, potentially, on that one person to make a decision, when that indeed may not have been the intent or is not the intent by having two people make the decision.

So these are some of the complexities. Look, I haven’t landed on a firm position of support or not on this, and those are some of the reasons for it. My overlying concern is how we navigate clear rules with these issues that have been expressed eloquently on both sides of the committee as this debate continues, and I do look forward to hearing a few more contributions.

I move, That the question be now put.

Kia ora, e Te Mana Whakawā me tēnā tātou katoa. This evening I speak from a professional perspective as a practitioner having worked in mental health law for many years—a couple of decades, actually. The member seated in the chair beside you, David Seymour, is well aware that when this debate first came about, before it went to public submissions and hearings, I had cautioned the member and actually provided some professional advice from my experience as a practitioner in mental health and compulsory treatment assessment law—that Act dated 1992—that there were clear safeguards and protections in place, which would be a good premise and guideline and a baseline for this proposed legislation.

There are a number of lenses and context that I will be addressing the committee on, particularly around clause 8, and it has been debated at some length—excuse me, just picking up my notes—but not from the perspective of a cultural lens. As a Māori practitioner and as a lawyer working in the field, it’s very clear, actually, and the member is, again, well aware, that the Mental Health (Compulsory Assessment and Treatment) Act 1992 has clear guidelines there in terms of the engagement from a cultural perspective with family, whānau, and the wider social construct. In fact, clause 8, as is proposed under this law, may have been well guided and supported by looking at the Mental Health Act. Section 5 under the mental health Act specifically talks about powers to be exercised with proper respect for cultural identity and personal beliefs. There’s no such inclusion under this proposed law. I premise, again, from a professional basis, as a lawyer and as a Māori woman working in this field, that this proposed law is culturally unsafe, but it is also unsafe to the individual and the most vulnerable.

I don’t have any prepared notes, so I’m speaking very much based on my experience from the head—the logical, rational side—but also strongly from the heart. The cultural lens that I hear when we talk about wellbeing, welfare, protecting the most vulnerable—this legislation doesn’t do that. I’ve heard time and time again in this House, and, particularly, we debated in the House earlier this year the Coroners (Access to Body of Dead Person) Amendment Bill and the importance of the engagement from a cultural perspective around how we care for and treat the deceased body. There’s nothing about this in terms of how we care for and protect the living body and the vulnerable person. Should I get the opportunity to talk about that further at another call I will, but I also will share that whanaunga Dame Tariana Turia, who is an advocate speaking against this bill, is saying that this would allow a person to request a euthanasia death without talking to their family—section 8. I harken to my colleague across the House, Louisa Wall, talking about encouraging the medical practitioner—and a medical practitioner, by the way, is not somebody who has specialised in the area of establishing competency; that is what a psychiatrist is there to do, and that only comes about at the third level of an assessment.

Under the mental health Act, Madam Chair, I again draw to the attention of the member beside you, David Seymour, that it’s clearly outlined, the stages and steps that are there and required to check that the most vulnerable person, who is the person labouring under a supposed mental health disorder—in this instance, a vulnerable person who is labouring under the decision whether or not they’re competent to decide to live or to die. There are clear guidelines that are safe and stepped out under the mental health Act that should have been there as a baseline around the safeguards and the protections of this proposed law.

From a professional basis, this has got to be one of the most irresponsible, repugnant, unsafe proposed pieces of legislation that I have heard put before the House, and we will continue to debate strongly against it until such time that those safeguards and those protections for the most vulnerable are put in place with a cultural lens and perspective. Thank you, Madam Chair.

Thank you, Madam Chair. It’s a pleasure to take a call in Part 2 of this debate, and if I might just briefly mention, in Part 1, I raised that I had three concerns that I entered this debate with back in the last election campaign and have carried through to this stage of this bill’s traversing through the House. The first was that the conditions initially were far too broad and would involve the court far too much in people’s lives. Not only do I feel that our lives are best served by as little Government involvement as possible; I also feel they are best served by as little court involvement as possible as well. The member’s Supplementary Order Paper (SOP) 259, which I will also talk about in this part, addressed that to a great degree. The member, in responding to my comments, then said he hoped that he would achieve three out of three of my concerns, and let me just say this is not going to be a pot-belly thriller—and I say that without the hint of irony at all. He has met all three of my concerns. The two that are addressed in this part relate to coercion, and particularly elder abuse, and the third being conscientious objection. I’d like to deal with both of those in turn, and I’ll deal with conscientious objection first of the two, simply because it’s most easily contained.

If we look at new clause 5A on conscientious objection, the part that concerned me and that I felt didn’t get a lot of debate prior to the bill entering the House was if we’re all about protecting the choices of people to choose how their life might end, then how do we respect the wishes of medical practitioners who do not wish to be a part of that? It was deeply concerning to me that the bill and what we might enact would respect those that do not wish to be a part of that. The member’s SOP, I think, addresses this very well. I know and I thank him for making not only himself but other advisers accessible to members of Parliament to question this. In reality, what this clause will mean is that if a practitioner does not wish to participate, not only are they able to not, but their wishes are respected so that they have to only give the most minimal level of information to the requester to help to point them where else they can go. The medical practitioner does not have to give so much information that they feel that their own objection is either disrespected or called into question. I think the member has done very well in addressing that particular part. Those that do object will not be drawn into the process in any meaningful way.

The second one, which is of the greater importance, is around coercion and particularly elder abuse. We get roughly between 2,000 and 2,500 cases of elder abuse reported in New Zealand each year, and we could quite reasonably think that that is merely the tip of some sort of an iceberg. So it’s important that if we are going to consider passing legislation like this, there are sufficient elements in it which give us confidence that we can mitigate the possibilities of such coercion taking place. I want to be very clear here. Some members I’ve heard talk in terms of absolutes, and not only is that not possible in this bill, but I’d caution all members that, quite frankly, that’s not possible in any piece of legislation this House has ever passed or will ever pass. But what we can do is ensure that we take very sensible and practical steps to mitigate risks, as we do in all other legislation that we consider. I thank again the member for making not only himself but others available to talk through this.

When I look through this—and I have studied the provisions here in this Part around the process of requesting through to receiving the medicine for assisted dying, or the treatment for assisted dying—there are very clear provisions about ensuring that not only is the mental condition of the patient assessed repeatedly, but that anyone having concern or suspecting that there might be undue external influence can and must put a halt to proceedings to investigate that further. I will stand here and say that none of us can be absolutely sure that these provisions will result in no one ever being coerced, but we can have confidence—[Time expired]

I move, That the question be now put.

Thank you, Madam Chair. This is only my second call on Part 2 of this bill, and I made that comment when I spoke in Part 1—I hadn’t spoken in the first and second reading—that I felt that this had been a very respectful debate with intelligent contributions on both sides of the argument, and I still feel that way, but I just want to make a plea to those members who are trying now to shut down the debate to remember that this is a bill that attracted a record number of submissions. There are tens of thousands of New Zealanders listening to this debate as we speak here tonight who have a deep, personal interest in this issue. There are a large number of amendments. It is absolutely incumbent upon each and every one of us to do justice to that.

Unfortunately, we can’t cover the full gamut of submissions, but what I would like to do in this call is to draw attention to three very significant groups or entities within our community and ask the member in charge of the bill to answer some questions to them, because as we look at the amendments in Part 2, a lot of them are around trying to protect organisations through freedom of conscience and that sort of thing. Now, the first one I had just started to draw attention to when my last call was interrupted, and that was from Hospice New Zealand. I ask the member in charge of the bill what he says to Mary Schumacher, who is the chief executive of Hospice New Zealand—and the 19,000 hospice procedures that are performed each year and how many people are represented by those—that the desire to ensure personal choice for a very small number of people who would want euthanasia will have a great impact on everyone diagnosed with a terminal illness in New Zealand. Does he agree with that comment, and what is his—he’s shaking his head. He doesn’t, it would appear, but what is his response to Hospice New Zealand?

I’m sorry I can’t do justice to all of them, but they have made some points and I’d like to put some of them on the record and ask the member to respond to them. Hospice New Zealand is supporting the concept that organisations would be able to object conscientiously. They make the point in relation to the Hon Michael Woodhouse’s amendment that its inclusion would give hospices and others the right to choose whether they object as an organisation or not. It would allow hospices to operate under their founding tenet of neither hastening nor postponing death. It would ensure people wanting euthanasia can still access palliative care services and hospice services, but if they wish to have euthanasia as part of their end of life care, it won’t be undertaken by a hospice employee or at a hospice inpatient unit of an objecting organisation, and it will ensure that there is no disruption to funding from Government for organisations who object. I ask the member to respond to Hospice New Zealand, to those particular points. Why is he so determined to push them down that particular path which is putting them into such a difficult position?

The next one—and I’m sorry I’m going quickly, but it’s from the New Zealand Medical Association. I simply mention Dr Kate Baddock and have no chance to go any further, but she drew attention in her correspondence to all MPs to a study of Quebec palliative care physicians’ views on euthanasia that found that all of them opposed voluntary euthanasia. Only one of the 18 in the study felt that religious or political beliefs had influenced their views. Instead, it was their professional experience in caring for dying patients that led them to oppose such legislation.

Now, we’ve all received that from doctors. We all acknowledge that not all doctors speak with one voice, and probably not everybody in hospices do either, but that enormous list of doctors around New Zealand who do not want us to pass this bill—many of them having written to us saying we would utterly compromise their profession if we do that. I have had people in my own city of Hamilton say to me—those who are working in palliative care teams and who are doctors—“We would feel so compromised, we might well feel we had to leave the profession.” Where on earth would we be in this country in the provision of palliative care if a substantial number of those people felt so compromised and put in such an invidious position that they left the profession? We mustn’t do that to them.

I have met with the palliative care team at Waikato Hospital. I have met with the team at Hospice Waikato in my city. I have heard their concerns. I simply ask the member, in the bill, to acknowledge them as well and, in particular, to say why he won’t consider these amendments that are being put forward.

The final one—and I’ve only got 30 seconds—is just to highlight the concerns that have repeatedly been put forward by the Disability Rights Commissioner Paula Tesoriero, because she speaks for the numerous people who live with disabilities in our community who are deeply concerned and who are actually terrified. Many of them turned up at submissions in my city and right around the country and spoke, often wept, with the fear that they feel, at how vulnerable they feel. I ask the member in charge of the bill, and those opposite who are trying to shut it down, please to give an answer. Hear their voice—[Time expired]

Can I just bring it to everyone’s attention that we are starting to get quite repetitive with some of the arguments. All of the Supplementary Order Papers have been spoken to at least once. So I am now looking for new material, otherwise I will accept a closure motion.

I move, That the question be now put.

Thank you very much, Madam Chair. May I start, perhaps in an unconventional fashion, to seek your indulgence for a two times five-minute call? I appreciate that’s a decision you’ll make closer—

CHAIRPERSON (Hon Anne Tolley): You haven’t got it. You’ve got one. You’ve only got one left.

I believe I’ve only spoken twice, Madam Chair. I would respectfully request that you—

CHAIRPERSON (Hon Anne Tolley): Oh, OK. But you’re not getting two.

Thank you very much—pardon me? I’m not getting—well, with all due respect, Madam Chair, I believe, having placed before the committee a Supplementary Order Paper (SOP) that I think is very substantial, both in terms of length but also in terms of the hugely important issue that it speaks to—in any case, I look forward to having the opportunity, at least as much as I am afforded, to speak to that.

Particularly, I’d like to appeal to those of our colleagues who have, by their own admission, stated that they are comfortable enough, in principle, with the idea of euthanasia, but have expressed real concerns regarding the specific provisions and processes within the bill, particularly the lack of meaningful safeguards, and have expressed a concern with how those would play out in reality, and have made it very clear to us—and we’ve heard a couple of such members speak tonight—that they will base their decision at the third and final reading on the way that these are addressed.

This is the context of my SOP 302. It is quite detailed in its provisions, and I’ve had a chance to speak only to some of that detail, and I’d like to continue to do so now. The purpose of an independent panel of practitioners to determine whether pressure is present, in my SOP 302, is specifically needed because the member’s bill, even as amended by his SOP, does not provide these provisions satisfactorily in itself. There is only one doctor who is required to turn his or her mind to the subject of coercion. We’ve got such absurdities as that person being expected to ensure that a person understands their options for end of life care. It is impossible ever to ensure that someone understands something. You can ensure only that the person is told those things. You can lead a horse to water, but you cannot make it drink.

For the absurdity of someone in a white coat who is respected as an authority figure, particularly by elderly New Zealanders, to be questioned in terms of the information that’s provided and in the nature of, supposedly, a free and frank exchange of information, but, in fact, in the nature, many would feel in that situation, of a directive, for that person to be merely having to do their best, without any reference to what exactly that might look like in the circumstances, quite frankly, is absolutely absurd. That is why I have taken the trouble to put forward an SOP that actually sets out some meaningful safeguards, and I say to members who might be more likely to vote for the bill as a result of that getting passed—well, I have mixed emotions about that, because I have made no secret of the fact that I don’t regard the practice of euthanasia as safe in any case, but at least for those members who are basing a decision at the third and final reading on whether the provisions of Part 2 in particular are in fact safe, would they please give serious consideration to the particular points within my SOP.

Those are, as I have touched on briefly before, the establishment of a panel of no fewer than 12 members, a membership that’s specifically designed to have a breadth of experience that is particularly relevant—social workers and elder abuse experts are very relevant for reasons that colleagues have already spoken to, and I will not repeat that material. The purpose of having the chair of the panel appointed by the Governor-General on the advice of the Attorney-General, after consultation with the Minister of Justice, Minister of Health, and the Minister for Seniors, is an attempt to reflect in the process the reality on the ground that, actually, decisions in this space will invariably be matters of justice, invariably be matters of health, and invariably be matters under the purview of the Minister for Seniors—except, of course, when it’s a younger person, but overwhelmingly it would be an older New Zealander. These people—I’ve gone into the trouble of spelling out in the SOP—could not be appointed members of the Support and Consultation for End of Life in New Zealand Group or the review committee either, because that would constitute a conflict of interest.

So I’ve gone, again, to some considerable trouble to spell out these matters in good faith in the hope that they’ll be adopted by the House, including, in particular, to have specific requirements about a report to be written in each individual case. The purpose of a report, of course, is that there’s an evidential record of exactly what’s been considered, of exactly what’s been decided, and this is the detail that I’ve put in my SOP that’s, frankly, not in the bill. I challenge the member in the chair to explain why he has not included in his bill a process more robust than one medical practitioner who never needs to have met the person before making such a decision.

Thank you, Madam Chair. I rise to speak to Supplementary Order Paper 259 that I want to address the House about. Record-keeping and being able to establish a register is, I think, an incredibly important part of this legislation, were it to pass. We’ve seen in overseas jurisdictions that many doctors—because of the onerous paperwork; because, potentially, they are afraid of the scrutiny that might come if they report on the deaths that they have presided over—simply do not bother or feel that they need to keep decent records. There are no penalties. There are no provisions for it in several international jurisdictions, and nor are there in this bill, which is why I have put this SOP forward.

I think keeping accurate records is vital. Trends in any data that can highlight areas of concern for the Minister are, I think, a very important thing. A registry, which I have suggested in my SOP, is a register of cases relating to a number of key factors, which I would like to spell out for the committee now and ask support for, because it does appear to me that there is a level of sympathy for people who have been coerced—elder abuse and so forth—but also how do we know what has happened unless we make good records?

So I have indicated in this SOP that a register should be established and maintained by a registrar and it has to record the following details: where someone died and where they asked to first access assisted dying. This is because if we are looking at regional trends—places, for example, where palliative care is not so readily available—when there’s a large spike in deaths, in Gisborne, for example, or Gore, these places need to have a clear idea if there is a maverick doctor or if there is practice that’s going on that is not good. There isn’t any provision for that currently, and I believe that there needs to be. It also needs to be very apparent—which is why in my SOP I have made it so—that a request, if it is made under clause 8, must be recorded. It must also be recorded if a person is a victim of coercion or elder abuse in the opinion of the medical professional and the one that might tap in on Skype—that second medical professional—so that if coercion has occurred and they’re refused assisted dying, then there would be a record of that.

It is important to understand the ethnicity, the sex, and the age of the individuals. These are all things that I feel are very important. Elder abuse, as we’ve said, can take many forms, many of them subtle, and I think that feeling worthless and a burden, unloved and unwanted, passed their use-by date, and costing too much to keep alive are the kinds of key indicators that a registrar must keep note of and must really make provision for, so that we as a society, if this bill were to pass, would understand what was happening.

Record-keeping is woefully inadequate internationally, and the second SOP that I’ve put forward as a proposed amendment, SOP 319, states that if any of the reporting requirements were not complied with fully, then there would be consequences: “the Registrar must recommend in writing to SCENZ that the non-complying medical practitioner or nurse practitioner not remain qualified to perform assisted dying services under this Act.” So at the moment, there are no penalties. If people choose to cover up their bad practice and so forth, there are no provisions in this bill to have a record of that, which is why the register, I think, is so very important.

We have talked about Michael Woodhouse’s Supplementary Order Paper 295. I would like to speak to that briefly, on a point that has not been covered so far tonight. As someone who’s had a 20-year involvement with hospice in New Zealand as a patron and has been involved closely on many boards of many hospices, I know how strongly they feel about the conscientious objection by an organisation. One of the things that hasn’t been alluded to are the pressures that have come on to any State-funded organisation—that if they get public money, they have to deliver euthanasia. In Canada, we’re seeing a lot of pressure being put on some of the faith-based organisations, and as Michael Woodhouse has pointed out and has explained in more detail previously, it is incredibly important that they should have that choice to refuse to provide euthanasia. I know how important it is to them from the very outset to be clear with their patients, to understand that they deserve choice, and that rest care facilities, long-term hospital care, dementia care, palliative care—they have the right to choose not to be involved in this. They have the absolute right. This bill does not give them that provision.

I would ask the member: should district health boards fund assisted dying, yes or no? Another question that I would like the sponsoring member to get to his feet and respond to: should public funding be conditional upon delivering assisted dying being offered?

Thank you, Madam Chair. This is my second call, and this time I would like to talk about clause 10 in terms of first opinion and second opinion, in terms of the risk of a wrong diagnosis and wrong prognosis. Before I actually get to that, I would like to address the comment that Brett Hudson made in terms of how members in this House cannot make an absolute correct decision. I would have thought that this was the one time that we wanted to be absolutely sure, because we are dealing with people’s lives—we make a mistake and we’re sending people to death. There’s no coming back from that: death is absolute. I would’ve thought that members would want to make sure that we want to protect the vulnerable and we want to protect the people who are perhaps coerced.

I won’t actually go into talking about the coercion, but I would like to acknowledge Harete Hipango, who talked about the cultural perspective. I know that earlier David Seymour had actually tried to say that, you know, I apparently speak for all of the Korean people. Well, let me actually mention to that member that I am not a white Caucasian male, so I have no idea about his perspective or his culture, and he certainly does not know what it’s like to be a Korean female, and he does not know what is actually relevant in the Korean cultural perspective.

What I want to talk about is the wrong-diagnosis issue. A couple of weeks ago, when we were debating the Part 1 aspect of this bill, I walked out of this debating chamber and actually managed to engage with a staff member who works in the parliamentary precinct. I will not mention who that person is, but that person actually mentioned to me that 23 years ago, she was diagnosed with terminal cancer and was given six months to live. She is still alive 23 years later. She also participates in this parliamentary environment in work. She also actually participates at our Christmas function and entertains everyone here. She actually told me how grateful she is that this bill was not in place back then when she was given the choice to terminate, because she certainly would have felt the pressure to not be a burden on her family, to perhaps commit—you know, actually decide to die, because that would’ve been the choice given to her. I’m glad she didn’t.

Now, I want to talk about the diagnosis. The risk of wrong diagnosis and wrong prognosis is actually very significant. A 2012 study actually found that 28 percent of autopsies report at least one misdiagnosis. A study of doctors’ prognoses for terminally ill patients found that only 20 percent of predictions were accurate within 33 percent of actual survival time. The Mayo Clinic in the USA cares for more than 1 million patients a year, from all over the USA and other countries, who have serious illnesses. A recent study found that a staggering 88 percent of patients who go to the clinic for a second opinion or confirmation of their diagnosis actually go home with a changed diagnosis.

So in this clause 10, the first opinion of the medical practitioner, I would actually say that I would like to question—in the experience of the staff member that I talked about, having been given six months to live 23 years ago, and she didn’t. She has lived 23 years after she actually survived that disaster of a diagnosis that she was terminal. She was going to be dead within six months. I would like the independent medical practitioners—actually, they should be specialists. They should have specialist training. It should not just be a medical practitioner who decides whether the patient can actually decide to terminate their life.

In terms of Dr Nick Smith’s comment about family having the right to actually make a comment, which Louisa Wall talked about, I think of the perspective as a parent. If my child was diagnosed with terminal cancer and he had only six months to live, I would have thought that I should know, as a mother of the only child—that I should know and I should be involved in the decision-making process of my only son. If I am excluded from that discussion, what a terrible thing this bill is actually leaving. It’s a terrible legacy, and I should hope that members think about that.

Thank you, Madam Chair, and thank you for the opportunity to take a second call on this. I would like to talk about Supplementary Order Paper 301 in my name that I haven’t discussed yet and I don’t believe has been discussed in detail so far.

But, firstly, I have a question for the member in the chair, David Seymour, which I would like him to give an answer to. It goes to the heart of his philosophical brand as the leader of the Association of Consumers and Taxpayers, and that is: how much time would it take for someone from the start of this process to the end of the process? So over the first request that they make to when they actually take the medication and die, what is the time frame that that will actually take? I think that’s an important question which isn’t outlined here in this legislation. There are steps—is it all happening in the same day? Is it happening over a week? Is it happening over three weeks? I understand that some of those time frames could be delayed because of the choice of the individual, but assuming that the choice was made to progress this in the fastest possible manner, what is the time frame that this would be done in? I’d like him to rise to his feet and answer that question to the House, because I think it’s something which all members—

💬 David Seymour: It’s an interesting question but how does it relate to ACT?

Well, all members would—I’m not going to join the ACT Party because of that question, but I would ask him to act and stand on his feet and answer that question.

Secondly—the Supplementary Order Paper 301 which I’d like to take a call to. This is in regards to clause 8 of the bill and is about when the request is made. One of the intricacies in when the request is made is—there are two elements which the Supplementary Order Paper tries to address. Firstly, it’s about ensuring that people have the adequate translation services available for them if they are “unable, uncomfortable, or unwilling to engage in discussion in English, Māori, or New Zealand Sign Language”, which are, of course, New Zealand’s three official languages. So this is about adding an additional element to the process so that it confirms the presence of a translation service in that part. I’d like to ask the member in the chair to be able to give me assurances that those New Zealanders who don’t have a strong grasp of any of those three languages are going to be adequately able to communicate their will to the attending medical practitioner in those circumstances. I’d appreciate it if he can give assurances to the House in that regard.

The second issue, and I think it’s quite important—it has been touched on but not in any detail as to my Supplementary Order Paper—is around the issue here in clause 8(2)(b). It says that the attending medical practitioner must “personally communicate by any means (for example, by telephone …)” or electronic communication—in the current bar 2 bill it says also using social media, and in David Seymour’s Supplementary Order Paper it says electronic communication, which I think is a broader term, and I understand where he’s going with that—“with the person about the person’s wish at intervals determined by the progress of the person’s terminal illness”. The question I have here, and this goes to my Supplementary Order Paper, is why are these conversations not happening face to face? Why are these conversations, these important conversations about the person’s prognosis, about the irreversible nature of assisted dying, the anticipated impacts of assisted dying, why are they not happening face to face? This comes to the issue of coercion and the fact that the doctor or the attending medical practitioner needs to be aware of the individual’s circumstances which they are under, and they are not even, potentially, having a face-to-face conversation with that individual.

I ask members whether they think that is something that they would accept. Would they accept that the conversations which are taking place between them and the medical practitioner could be happening on FaceTime, on Skype, or on some other form of electronic communication, or would they rather those conversations happen face to face so that the actual relationship, the fiduciary duties that the doctor has towards their patients, are being seriously taken and that we have doctors and medical practitioners who seriously look at these issues and understand the full context? I ask the member and I ask members to consider that question, and if they do not think this bill is adequate, to vote for Supplementary Order Paper 301 in my name to address it. Thank you very much, Madam Chair.

Thank you, Madam Chair. I thought I should try to address some of the concerns raised by members as quickly as I can. First of all, starting with Alfred Ngaro asking: does the second doctor have to be sure that the person is not coerced? Well, yes they do, because as I was at pains to stress in my opening contribution to this debate, they have to make sure that the person at all times is a person eligible for assisted dying. That means a person who has decided, in their view—no one else’s, in their view—that this is the best way to alleviate their suffering. So the answer to that question is: yes. Tim van de Molen gave, as usual, a very thoughtful contribution. I look forward to ongoing discussion with Tim about the details of the bill; no one’s engaged more meticulously, I have to say.

To Harete Hipango, she might like to know—in fact, she will have seen in Part 1—that actually we have adopted part of the compulsory assessment and treatment Act, the test for competence, into the bill. But I’d also say to her, and also to Melissa Lee, that sometimes it’s more important to focus on what actually brings us together, our common humanity, than try to continually put up distinctions between people. What I’d say is that the tests in this bill are the tests that any person should have to face before they can access assisted dying. Of course medical practitioners should be aware of the cultural nuances and expectations of different types of people. We don’t need to put it in legislation every time we make a law; that is already an expectation for doctors up and down this country.

Brett Hudson, I’m glad we’ve got to the trifecta. I look forward to continuing the dialogue with you. Tim Macindoe said the doctors object. He held up a list of 1,000 doctors that object. Tim, there’s 17,000 doctors in New Zealand; 1,000 is not actually very many. More generally, scientific surveys of doctors have found that about a third are in favour, about half are opposed, and about one in six aren’t sure. There are doctors in favour and doctors opposed, just like almost every other group. We had Chris Penk, effectively, advocating for a panel of people to decide whether a person could access assisted dying. I think that is a misconception of what this bill is about; it is actually about choice. It’s about the person being able to choose. There has been extensive debate, and it’s been researched and studied extensively by all sorts of jurisdictions—the most fulsome in recent findings were by the Parliament of Western Australia in their report, where it’s been found that, in actual fact, when you look at all the evidence, the two-doctor model of having professional doctors who talk with the person, who are used to making decisions about competence and consent, is the correct way to establish a person’s choice; not to have some sort of institutional panel put in place.

Maggie Barry said that there are no penalties for failing to fill in a form. I direct Maggie Barry to clause 27, which sets out the penalties for failing to comply with any requirements in this bill, including the many requirements to fill out forms and send them to the registrar—$10,000 or three months in prison; you’d have to be pretty lazy to take that instead of filling out a form. She also asked me whether district health boards should have to fund assisted dying. Well, that’s actually a choice for district health boards. I don’t know what will happen with particular district health boards. I suspect that some will choose to fund assisted dying services, but the model of healthcare funding in New Zealand is subsidiarity and local decision-making, and I support that model. If we look at what’s happened overseas in Australia and Canada, they have similar healthcare systems and structure, and they work it out at a local level.

Finally, Simeon Brown asked whether there would be translation and whether there would be an obligation to provide translators. I think he’s revealing a broader misconception about the bill. There are a series of obligations on doctors to ascertain that a person is a person eligible for assisted dying. If they require a translator to make sure that the person understands what’s happening, to talk with the person, to communicate with them, then they will have to either find a translator and actually ensure that they are having proper communication, or assisted dying won’t go ahead. So we find ourselves in a position where Simeon Brown, if anything, is helping to aid and abet assisted dying to go ahead by urging that there be translators so that people can get it even if they struggle with English, Māori, or New Zealand Sign Language. I think the point is that he has no concern here: a person with language difficulties won’t be able to access assisted dying—it’s not that they’re going to unwittingly access it—because they wouldn’t be able to fulfil the criteria of the bill if they couldn’t communicate in English.

So that’s my answer to the various concerns that have been raised around the Chamber. I hope that they are satisfactory. I wonder if we might see a closure motion shortly after I resume my seat.

I rise to speak on Supplementary Order Paper (SOP) 314, which is in my name, understanding that elder abuse is endemic in New Zealand and that a major study in 2015 found that 10 percent of elderly New Zealanders—nearly 70,000—have suffered some form of abuse either physically, sexually, psychologically, financially, or through neglect. Another study has found that 79 percent of elder abusers are the family or whānau of the victim—their friends and their children—and that the victims are often very old people in poor health, especially women. Financial and psychological abuse are the most common forms of elder abuse and neglect. Understanding this situation, the SOP that I am proposing is to ensure that when a person approaches a medical practitioner with a stated desire or wish be assisted in his or her death, that person be given clear and enough information about the end of life options that they have, and that they are clearly informed that they do not have to choose death at that point. The amendment that I propose is for clause 8, replacing paragraph (c), on page 6, lines 14 and 15, with new paragraph (c), to “ensure that the person understands their other options for end of life care, including the following in particular as valid legal alternatives to assisted dying under this Act: (i) [clearly,] palliative care: receiving pain relief that may have the incidental effect of shortening [their] life: [and] the person’s right to refuse medical treatment to sustain or prolong their life”.

Many times, when a vulnerable person gets to the point of making that decision of wanting to be assisted in their death, then the person may just not be aware of all the other options that they may have and all the possible treatments that may be given to them without having to go all the way to having assisted death.

This SOP amends clause 8, and it is an attempt to ensure that the person who is contemplating euthanasia or assisted suicide is fully informed of all the options available to them. It may just well be that the person who is already thinking of ending his or her suffering by assisted death just may not be fully aware and not be knowledgeable enough that the pain and suffering they may be experiencing at that point in time may actually be helped, and not have to resort to being assisted to die.

So, really, it is information, and making sure that that information is given to them, and making sure that they understand the information that has been provided to them so that they can make an informed decision going forward. At this point, if the person requesting to exercise the option of receiving assisted dying still wishes to proceed, the attending medical practitioner must exert all effort for them to be able to be certain that the person has been informed and is fully aware of all their options.

I move, That the question be now put.

Just a reminder to those who are holders of proxies, please double-check that the member isn’t here in person and voting, because they can sometimes vote differently.

And, just while we’re waiting, a reminder that a personal vote is not called for until the result is declared by the Chair. So we call the Ayes and the Noes. When I declare the result, those who feel it’s the wrong result can then call for the personal vote.

💬 Hon Member: They don’t have to.

No, they don’t have to.

I raise a point of order, Madam Chairperson.

CHAIRPERSON (Hon Anne Tolley): Point of order, the Hon Simon O’Connor.

Oh, look, I’m feeling better already. That’s very kind of you!

CHAIRPERSON (Hon Anne Tolley): I beg your pardon, the ordinary Simon O’Connor.

I was going to say “less honourable”. No. I seek leave of the committee that the subsequent votes, 31 of them, are carried over to the next members’ sitting day.

So you’re perfectly able to seek leave to achieve that. The way you do it is you seek leave for the committee to report progress.

Oh, sounds fantastic. So I seek leave of the committee that the committee report progress.

I’ll put that leave. Is there any objection? OK, there is.

The question was put that the amendment set out on Supplementary Order Paper 295 in the name of the Hon Michael Woodhouse to the proposed amendments set out on Supplementary Order Paper 259 in the name of David Seymour to Part 2 be agreed to.

I raise a point of order, Madam Chairperson. I seek leave of the committee for the questions on Supplementary Order Papers 304, 306, 318, 302, 320, and 321—those being all the remaining amendments to the amendment in my name, Supplementary Order Paper 259—to be taken as one question.

Leave has been sought to take that action. Is there any objection? Yes. There is objection.

The question was put that the amendment set out on Supplementary Order Paper 304 in the name of Simon O’Connor to the proposed amendments set out on Supplementary Order Paper 259 in the name of David Seymour to Part 2 be agreed to.

The question is—I really do think that you should be sitting down, Mr O’Connor. I don’t care where.

The question was put that the amendment set out on Supplementary Order Paper 306 in the name of Melissa Lee to the proposed amendments set out on Supplementary Order Paper 259 in the name of David Seymour to Part 2 be agreed to.

I seek leave for the committee to report progress.

Leave is sought for that. Is there any objection? There is no objection. I will report progress.

House resumed.

Bill reported with progress.

Report adopted.

The House adjourned at 11.21 p.m.