The End of Life Choice Bill

Written By: - Date published: 7:30 am, December 21st, 2017 - 155 comments
Categories: act - Tags: , , ,

On the 13th, the government recently withdrew several of its own Members’ bills, with no guarantee their replacements wouldn’t be Opposition bills, (luck was with Labour and NZ First backbenchers, however, and those two parties won all three new bill drawings) in order to advance the End of Life Choice Bill up the members ballot. This means we need to have a serious discussion both about the moralities and practicalities of euthanasia in New Zealand, and I think this is a reasonable issue to revisit, and probably one of the best things ACT in its modern, post-Banks incarnation has done, actually acting like the Liberal right-wing party it claims to be, and being permissive on social reforms.

That said, despite my usually strident stance as a liberal and champion of reform on social policy, this is not a Bill without complications, and this is an issue that in my opinion even supporters should be wary of. This is one of the few bills where I have actually listened to National Party concerns in the debate and actually said to most (but naturally, not all) “actually, these are valid dangers we need to be careful of in writing a Bill like this, and they might arguably have a bit of a point even if they’re taking it too far.” That doesn’t stop me from thinking that cautiously providing people in suffering and near the end of their life or with a terminal condition with a way to end their life with diginity is a good idea, it just makes me think this bill needs dramatic rewrites before it’s an acceptable starting point.

I’m going to do a quick rundown of what the bill does. And by quick, I mean it will be quick for analyzing a Bill that does anything more than a quick fix, so strap in, we’re heading past 2,000 words.

Eligibility and general problems

To even be eligible, people must be:

  • Over 18.
  • A New Zealander. (citizen or permanent resident)
  • Suffering from a terminal illness with a prognosis of six months or less, or have “a grievous and irremediable medical condition.”
  • In “an advanced state of irreversible decline in capability.” Capability is NOT explicitly defined in the Bill.
  • “[Experiencing] unbearable suffering that cannot be relieved in a manner that he or she considers tolerable.”
  • Be (presumably, mentally) capable of understanding both the nature of assisted dying and its consequences.

All of these are, with the possible exception of being over 18, necessary requirements of a reasonable assisted dying law. And the over 18 requirement is absolutely forgivable for a first-shot at this issue, as arguably allowing younger people assistance with the permission of their guardians is an issue that can be left until after the law is reviewed, and would likely need additional caution and/or safeguards beyond what’s in this Bill, because we should probably want to see how the bill works in New Zealand before we consider if it needs to allow for younger people in these situations to have a process to make a decision with the permission of their legal guardian(s). We could also argue with a six-month prognosis, but this does seem a reasonable point to open up the decision given the process seems to be quite lengthy, and sometimes prognoses are optimistic, so I hope those parts are going to remain uncontroversial.

The age restriction is intended to prevent young people taking this option before they’ve had a reasonable chance to develop. The bill definitely prevents large-scale death tourism by locking out non-residents, and prevents those who are mentally not competent to make this decision from being eligible. It may not prevent all death tourism, however, and it may increase immigration requests for, say, Australians who would like to end their lives, or other nearby countries with no law allowing this. The fact that we have laws around not necessarily accepting immigrants who are already sick won’t always stop people applying.

These requirements may not be is sufficiently broad in preventing bad outcomes. Where are they lacking?

Well, there is no requirement that the person’s reason for seeking assisted dying must be related to the effects of their condition, just that they have the condition and find their suffering intolerable, so arguably people who happen to be suffering and have a degenerative condition, but have other reasons to want to die, such as depression, could be said to qualify under the bill. (depression for reasons not caused by the patient’s condition is not usually a loss of capacity to understand, it simply influences decisions in ways that may be self-destructive or harmful, so arguably it should be excluded from the evaluation given current wording!) There is also no reasonable attempt to require affirmative consent throughout the process, just make people aware they can say no, and this issue should really be addressed in legislation that aims to deal with degenerative illness. Other laws that allow euthanasia are very clear that when consent is not obtained it is still illegal to kill someone. The law simply refers to what to do if someone chooses to receive or not to receive the lethal medication. It should instead refer to consenting or not consenting, so that a lack of consent is treated as choosing not to go through with the process.

There is also no allowance for the evaluation to actually conclude that the person involved isn’t in fact suffering, or criteria for what constitutes “unbearable suffering,” meaning that it’s completely open to a reasonable person test. Remember that “reasonable people” in jury decisions allowed us to beat kids with weapons before we repealed §59 of the crimes act, so while it’s an established legal process, that doesn’t mean it will be enforced well, and the risks for this bill letting things go wrong are very high, because we’re talking about people potentially dying when they shouldn’t, here.

Alarmingly, there is little consideration of the very real slippery slope effect this could have for the elderly, gradually broadening the definition of “unbearable suffering.” Already most people who would qualify or want to qualify are likely to be older New Zealanders, and we should be very careful about the effect it might have on our society to lose this many people. While there is provision to avoid active coercion, there is no provision to rule out contributory effects from feeling devalued, or a burden on the community, that arguably have been observed in countries that allow euthanasia, and whether these could be termed “unbearable suffering.” If I were drafting this bill, I would likely be referring to specific categories of symptoms that trigger eligibility rather than suffering in general, such as “intolerable pain,” or listing specific degenerative diseases that affect the brain. (just referring to loss of mental capacity arguably runs into issues with disabilities and the elderly, again, so it would need to be defined carefully to avoid this. Listing specific degenerative diseases, and giving the Minister of Health the ability to add more via the Governor General, would probably be the best bet to avoid this issue)

Finally, there is no separation between terminal or degenerative disease and disability- in fact the requirements can be read to explicitly include any sort of irreversible disability that involves progressive decline in capability, and this too is poorly defined and could broaden in definition over time if not spelled out explicitly in the Bill. There are very real concerns that this Bill will allow for disabled people to be euthanized, and this concern should be taken in the context of previous medical treatments having been performed on disabled people without their consent, often with painful or traumatizing physical or psychological side-effects. A lack of effort in addressing these concerns would likely cause the Bill to fail at second or third reading, because the Greens’ support at the very least in contingent on this issue being addressed.

Conscientious Objection

This was one of the points of objection that the conservative MPs in Parliament had that I most disagreed with. This bill has a thoroughly sensible regime around conscientious objection- any medical practitioner may object to providing this service, but they are compelled to tell their patients who request end of life options that there will be a SCENZ register available where they can find a practitioner that doesn’t object. This means that the patient is adequately informed of alternatives, but the objector never themselves has to do the direct referral, simply tell them that there is an organization which will arrange the referral for them. I would actually consider taking this approach a little further and allowing them to pass off the duty of informing their patient of the SCENZ register to any willing staff member, so long as they confirm their patient was in fact informed, allowing them even more moral distance from the act they object to.

This approach is in fact so sensible, that we should probably extend it to our abortion law, where currently women (or anyone else who needs an abortion) have no right to be informed of where else they might go to get an abortion if they ask someone who objects to providing one. Whatever your personal opinion on abortion, it is a safe medical procedure, (less risky than assisted dying, in fact) and it is absolutely reasonable if this Bill passes into law, to conclude Labour has no excuse for not extending the same treatment to medical practitioners who object to abortions. You could have the Ministry for Women provide the necessary information.

Currently the allowable penalties for failure to comply with this provision are up to three months of jail time, or a fine of up to $10,000 for most offenses against this act, so likely any non-complying conscientious objectors would simply be hit with a fine. I think that’s probably appropriate in most cases, although I can see a judge getting frustrated with repeat offenders and giving them a short stay in jail.

Providing full information and evaluating the request

This part of the bill is quite good, in that nobody can make a final decision on being assisted to die until they have been informed thoroughly of the nature of their condition, any other options for treatment or palliative care, the fact that they can change their mind at any time, informed of their rights both to talk to family, friends, etc… or not talk to them if they don’t want to, and there must be an effort made to ensure this person has not been pressured or compelled into the decision, in fact the attending practitioner is legally required to do this to the best of their abilities.

There is good evidence that making people aware of their options for end of life care including palliative care, and having them make a decision in advance actually decreases both unnecessary treatment and suffering, and desire for more radical solutions like euthanasia in cases where an option for reduced suffering exists that doesn’t require an early death or simply dying due to giving up, so discussing these options with patients in general is good policy, and I welcome its requirement in this bill because where these methods of giving dignity to the dying are utilized at a patient’s request they are a much more preferable outcome for everyone.

Either two or three medical practitioners must assess the patient independently, (a third is necessary if one or both of the first two cannot make a determination as to the mental capacity of the patient to make this decision) so there are reasonable provisions for assessment in the Bill, but again, assessment only safeguards against things the bill requires to be considered in the assessment, such as direct coercion or inability to make and/or comprehend the decision, and its consequences in the latter case. It also doesn’t provide safeguards to prevent involuntary death in terms of administering the lethal drugs. The requirement for a second independent assessment by a person chosen by SCENZ, however, is a reasonable safeguard against fakery regarding the assessment step in most cases, so it does make sure that eligibility is accurately determined. SCENZ will need to be careful, however, in how they assign people to each other, to ensure there is no room for collusion.

Confirming the decision

Basically, a lot of people are required to send a lot of paper trail to each other. While this is important to establish accountability and make sure people take their obligations seriously, this is one of the weaker parts of the bill, and does not in fact act as a failsafe, and I find the Opposition’s arguments reasonably damning here. More safety measures (such as legal requirements to ensure the patient is still sufficiently committed to this course with each evaluation that the process should proceed, rather than simply reminding them they can change their mind, or requiring an independent observer to be present who can halt the procedure if they think the patient is being/has been coerced or unduly influenced) may be a good idea for the initial introduction of this bill, perhaps with a sunset for some of the safeguards that can be triggered by the SCENZ watchdog group as and when it considers it appropriate, or with agreement by the Minister.

What the bill actually allows and requires

Unusually for such a Bill, this Bill allows for both assisted dying, (where the patient is provided drugs but chooses to take them themselves) and for medical practicioners to administer lethal drugs at the patient’s request. There is a very good argument on the precautionary principle that we should start with just assisted dying where the patient actively has to take the drugs themselves, and leave a provision in the law that if SCENZ has no ethical concerns about how the law is being applied, that we can proceed to allowing medical practitioners to administer drugs, too, as in my opinion that is the most dangerous step, because it can theoretically be done by force rather than requiring co-operation.

It also has some reasonable requirements about dealing with medication that isn’t required due to last-minute changes of mind, but again, this focuses a little much on creating a paper trail compared to actual safeguards, although this may be because those safeguards are implicit in requirements on pharmacists and similar professionals.

It also requires SCENZ (an agency set up to assist with administering the law, “Support and Consultation for End of Life in New Zealand”) to report on statistics and concerns to the responsible minister regularly, and makes various provisions relating to BDM that don’t immediately seem controversial.

This bill explicitly states that it doesn’t interfere with or change existing rights in law to effectively end your own life by refusing treatment or food, which is probably a good thing, as these are important legal principles and are well-integrated into our medical ethics in New Zealand.

What’s missing

This bill allows immunity to conviction (presumably on murder or similar charges) for people offering assisted dying in good faith who took reasonable measures to avoid negligence. This is effectively the heart of the bill, and is very simply drafted. However, this is arguably also a problem, because it might require an experienced lawyer to draft instructions on how medical professionals maintain that immunity, and it’s possible that even if these concepts are defined well and uncomplicated to interpret, they may be difficult to explain well to lay people. While the general concepts are easily explained to someone with passing familiarity to the law, and thus likely to any good nurse, (compliance with the law is a large part of the job) the border cases might be difficult to define. I would have preferred an approach where negligence is well-defined in the law as failure to comply with specific provisions to a specified standard, rather than simply leaned on as a legal concept. Good faith is relatively self-explanatory- you are liable to murder charges if you collude to trick someone into ending their life, or to do it for profit, or any other motive that is against the patient’s best interests. This prevents situations where we’re allowing collusion by prison medics to kill prisoners, or allowing killers who are demonstrably so-called “angels of mercy” to have legal immunity, but there needs to be more safeguards to prevent these types of people from potentially infiltrating the medical profession and actually killing people rather than offering a dignified end to those who want and need it in advance, because preventing murder is literally the first job a society has, and there is a reasonably thin line, although an observable one, between euthanasia and murder, or assisted death and suicide. Likely, the opportunities will be rare enough that serial killers, at least, will not be a concern, but we should be cautious at first because any failures in this legislation are very high-stakes.

As I allude to above, the bill is a very strong approach to euthanasia, and fails to include phase-in or phase-out periods for safeguards and additional methods of assisting people to die with dignity that arguably could cause a slippery slope.

As above, there also needs to be a lot better work done about properly defining eligibility in a way that doesn’t allow loopholes or potentially stigmatize disability and old age.

There are also tricky issues of risk around prognosis of terminal illness versus actually having a given terminal illness, and the accuracy of prognoses. Often we just don’t know enough to give accurate timeframes or even diagnoses of when and whether a person has a terminal disease. While doctors often do very well, there is a very real risk that people without a terminal or degenerative condition will end their lives on inaccurate information, and we won’t find out until after their death. I would hope that this is an issue that receives a lot of debate in public, and in parliament, because we may need some reasonable safeguards in the law here.

If you’d like to submit on the bill, Parliament has opened submissions. You can read the bill on our legislation site now if you want to check parts or the whole for yourself to check if you agree with my criticisms or praise. I have already made a submission along the lines in this post, although it is not worded exactly the way I have worded my feedback here, to avoid it seeming like a form letter if anyone chooses to lift parts of this post for their submission. (which you are all welcome to do if any of my criticism or praise speaks to you)

155 comments on “The End of Life Choice Bill ”

  1. Rosemary McDonald 1

    Since yesterday’s unveiling of the Government’s medical cannabis reforms do not specify what happens when a person who is allowed to use cannabis as pain relief (only if they have 12 months to live) fails to die when the specified 12 months have elapsed.

    I guess this Bill will solve that potential problem….

    • tracey 1.1

      The Medical Cannabis Bill is an example of what happens when something is tampered with so much it might be better not to have it at all.

      It amazes me that our MPs are fronting up to end of life challenges but do not have the collective courage to legalise cannabis fullstop. Beggars belief.

      Intense pain is one reason, of many, that people want to kill themselves. If smoking dope gives them a quality of life it should be permitted imo.

      It does seem incongruous that we are discussing legal ways to end a life while tying hands behind backs around cannabis.

      • The Fairy Godmother 1.1.1

        So agree with you. My mother is having horrible side effects from oxycodone. (Pharmaceutical grade heroin) so she goes off it and then she wants to die and prays loudly for God to take her now. I just wish she could try marijuana if that would help her.

        • tracey

          I feel for you and your mum.

        • cleangreen

          God I feel your pain fairy godmother.

          When I was chemically poisoned for the fisrt six months when the pain ripped my body apart as the immune system was attacking my body thinking it was helping it would have been helpful to ave good medical doctoring to treat chemical poisoning affects and their impcts but no such treaments were available so now after we found two doctors one in Canada one in Florida my health slowly improved and the pains subsided.

          I nw medicate myself now after 25 yrs living with the long term effects of chemical poisoning.

          We wish your family would recieve some assitance from doctors now that we have a new compassionate government, and please dnt give up hope as it was hope that got me through all our family had to endure.

        • Rosemary McDonald

          TFG….watch the youtube clip here… ….the manufacturers of oxy have a solution to one of the most serious side effects of their product.

          And they’re very proud….

          Kia kaha.

      • Rosemary McDonald 1.1.2

        “If smoking dope gives them a quality of life it should be permitted imo.”

        We need to move away from the narrative that medical cannabis is ‘smoked’.

        Already there are oils and tinctures that are placed in the mouth (usually under the tongue) and balms that when massaged into areas of pain can give extraordinarily good relief. Medicinal cannabis is being made into capsules.

        To my knowledge there have been no reports of adverse effects from using these products, at least not the ones that have been produced and supplied ( often at no cost) by the established ‘Green Fairies’.

        Sometimes, and I understand it is not usual, medical cannabis is vaped.

        Its no wonder that the old fuddy duddies that appear to be dictating Winston’s intractable stance on this issue are nervous when the narrative that the only way of using cannabis is by setting fire to it and inhaling the smoke persists.

      • Whispering Kate 1.1.3

        I just cannot comprehend why this bill is only considering people with a teminal illness, what about people who live with chronic pain – sciatic pain for one example which is unbearable, frankly the terminally ill finally are released from their pain but the chronically ill live with it, it doesn’t kill them but makes their lives a misery. That this Government tinkers around the edges of this bill but can go through the motions of making euthanasia legal is horrible beyond belief.

        Let people grow their own dope – its easy to do – take the criminal aspect out of it and just start governing properly, not just dancing around the edges of laws which need to be implemented. Adhern said she had no problems with legalizing cannabis for the ill and chronically disabled people – just do it Jacinda for f…. sake.

      • Sabine 1.1.4

        they, at the very least could decriminalize the possession and use of it. A bit like the Netherlands.

        But i guess that is in the to hard basket, and besides, someone could have fun with it. And that can’t be. IF you want to have fun get pissed.

      • One Two 1.1.5

        Completely agree with your comments on this thread, tracey

        Why indeed are these two bills which are polar opposites at face value in terms of intrinsic ‘risk’…

        Seemingly being embraced the wrong way around…

        I would suggest its obvious, but that’s only my point of view..

        Death, not life being to the fore of the directives and policies deployed at home and abroad

  2. Tracey 2

    Reduced capability and unbearable suffering are read together. Being disabled does not mean unbearable suffering per se and is something of a safeguard for someone with a disability wanting out cos of the disability. It is also a chance for us to become more enlightened in our attitudes to disability. For example giving a liveable income not a subsistence income. I am constantly amazed at how many people with disability do not kill themselves given the pittance we give them reducibg tgem to survivors not thrivers. Simple things like a trip to another city or town to visit friend or relative. Not on a benefit you dont.

    Doctors and Nurses Councils will draft extensive guidelines if they have not done so already in anticipation. Perhaps those should become Regulations to the Act?

    I hope that during this process the experience of other nations will be explained to the public to help us get the best understanding.

    Thanks for the post Matthew. I know it would have taken a long time to put together.

    • Rosemary McDonald 2.1

      “I am constantly amazed at how many people with disability do not kill themselves given the pittance we give them…”

      For some in the disability community staying alive and, as Draco T Bastard put it the other day…

      “4. Keeping them alive takes up resources (food, doctors, medicine, nurses, etcetera) that would be better used to keep someone else, who isn’t at deaths door, alive.

      That’s the one that you’re really going to hate but it happens to be true. Our resources aren’t unlimited and so we, as a society, have to choose which is the best option for the person dying, for those who can actually be helped with the use of our limited resources and society.”

      ….is activism.

      Perhaps DTB and his like minded and oh so virtuous friends could generate a list of those members of society who are not worthy of consumption of ‘resources’.

      It must be so simple in his world.

      • Tracey 2.1.1

        I am slightly confused by your post. I was referring to people who have a disability, not who are dying and to the fact that we limit their employment opportunities by our attitudes and those who cannot work arecreduced to subsistence. We need to address that and one way is giving them the average wage. Yes average. And watch how quickly Nats stop using average wage as a measure if we did. They would suddenly champion median wage as a measure.

        Bill English is incandescent about this Bill but his recotd of supporting the livibg is appalking. EG benefirs to those who are disabled.

        • Rosemary McDonald

          “…people who have a disability, not who are dying ”

          Effectively one and the same (In the context of throwing valuable resources at folk who are not going to get better) especially if the disability requires a very high level of supports…and I’m talking about nursing care, and medications, and equipment and medical supplies to manage various bodily functions that no longer work…all products that are already rationed to those with high and and complex care needs who are not covered by ACC.

          • tracey

            Then why are we not seeing backdoor euthanasia on these folks now or are we? I think that bow is being drawn way too long.

            • Rosemary McDonald

              Excuse me…but denying treatment to someone with an existing disability happens…often.

              Subsisting on a benefit because of a disability or chronic health condition is bad enough, but combine that with having to re use pre- packed sterile single use catheters because the dhb will only fund 20 per month (it used to be 10) and you live with constant bladder and kidney infections that make you feel like shit all the time and yes, feel like death would be a blessed release…

              • tracey

                I get that Rosemary and where is English and other morally outraged anti End of Life people on that? Silent and in English’s case complicit in the degradation of those lives.

                He is outraged by this Bill but seemungly totally incapable of seeing how he has been part of making some people’s lives such a misery that they seek death as the answer.

                I see no one having the coyrage to challenge him this way.

                • Rosemary McDonald

                  Sadly, tracey, its not just English and his National mates….at the risk of opprobrium…Labour did/does it too.

                  • tracey

                    I agree. I confess I havent looked at who is opposing so picked on English. Mostly cos he has had his hands on finances for 9 years to make a genuinely christian impact on the lives of the vulnerable

                • Matthew Whitehead

                  Quite. Very loud whenever their prescriptive morality is challenged, but ask them for resources to make life bearable instead and he’s suddenly awfully quiet, or goes on a rant about how that’s Not The Government’s Job, and people need to be independent of the state.

      • Perhaps DTB and his like minded and oh so virtuous friends could generate a list of those members of society who are not worthy of consumption of ‘resources’.

        It would still be their choice and not anybody else’s.

        And, yes, someone choosing to die before their life becomes intolerable to them will free up resources that can be used to help others. That’s simply a fact and one that we need to accept and take into account when considering euthanasia laws.

        • Rosemary McDonald

          “It would still be their choice and not anybody else’s.”

          You’d have to make damn sure that it is a real ‘choice’…not something they have been marginalised or guilt tripped into making.

          “See, I’m a truly virtuous member of the community because I choooose not to persist in consuming valuable and limited resources in keeping my terminally ill/degenerative diseased/disabled arse alive…”

          Because, almost every single comments section in articles in MSM is liberally peppered with this narrative.

        • Katipo

          Speaking of resources I can’t help wondering how many people would choose to end their lives with this legislation vs how many more would have improved lives if the costs, time & effort involved with implementing and administering this legislation were redirected into palliative care.

    • Matthew Whitehead 2.2

      It shouldn’t mean that, Tracey, but the terms used in the bill are very ill-defined in my opinion, and I’m very worried about definition creep. Remember, in the law, it’s whatever the person requesting to end their life deems unbearable, not anyone else.

      • tracey 2.2.1

        But it is an and situation not an or situation isnt it Matthew so

        Unbearable pain; and

        ” Suffering from a terminal illness with a prognosis of six months or less, or have “a grievous and irremediable medical condition.”

        Neither of those will be definable by the sufferer but by the medical profession?

        • Matthew Whitehead

          So, whether they have a terminal illness or irredeemable medical condition is a medical diagnosis, sure, I am very conscious of that. I’m also conscious of the fact that it is an “and” relationship, not an “or.” But, the point is, not everyone who has a terminal illness or an incurable medical condition is in fact suffering at all, or in an “unbearable” fashion, at every given point after their diagnosis, but they could genuinely feel they are and be wrong, because of how life-shattering those diagnoses can be.

          The point is that with the patient being the only one legally allowed to determine the unbearable threshold of pain, you get into a situation where as long as the two evaluators of the patient’s condition don’t feel the patient is actually lying, they can end their life for reasons Seymour or the people considering this law probably didn’t intend or anticipate, even if those medical professionals would disagree that they are in extreme suffering, and that their case isn’t one that should qualify. (This is why English claimed in the debate that people who are depressed might qualify- because they just need to be genuinely depressed to the point they’re not lying about how they feel about their suffering, and have either a terminal illness or qualifying medical condition at the same time) It seems obvious that the intent was that there be genuinely and objectively extreme suffering to the point that the patient’s determination of it being unbearable is reasonable, and that the patient’s opinion be given heavy weight in that determination. I feel it’s a huge mistake to allow no say to the two people evaluating the patient’s condition in whether that suffering is in fact objectively of an extreme nature that warrants them to be allowed to take their own life. There needs to be some degree of check on the patient’s own opinion, so that the evaluating practitioners can veto people who are seeking to end their life for highly subjective reasons, or for reasons that don’t relate in some way, even indirectly, to their condition or illness.

          The same way that we should be worried about whether this bill safeguards sufficiently against involuntary euthanasia, we should also worry about it being used to allow people to end their own lives when they’re still able to live a happy life, but for whatever reason can’t see it at the time. Not everyone is always a perfect judge of their own circumstances, and there need to be safeguards against that given that the final decision is irrevocable.

  3. red-blooded 3

    A really thoughtful discussion – thanks, Matthew. I’ve also been thinking about this bill, although I can’t claim to have explored it as closely as you. I’ve got mixed feelings about this issue – definitely sympathy for people stuck at the moment with no choices, but concerned about loose definitions and possible complications. In particular, I worry about people who are feeling like a burden. Loneliness or lack of support can be very real issues for people with long term health problems but we should try to provide other possible solutions.

    I certainly hope we can make progress with this issue, but I’m not comfortable with the bill as it stands. It’ll need a lot of work at select committee stage. Either that, or lessons could be learned from this bill and a more thorough version developed.

    • tracey 3.1

      There are provisions to address the lonliness etc situation

      “Either two or three medical practitioners must assess the patient independently, (a third is necessary if one or both of the first two cannot make a determination as to the mental capacity of the patient to make this decision)”

      Having spoken to , mainly, nurses on this issue I partly see this Bill as protection and guidance for them. Nurses are in the frontline of this issue because they are the ones confronted by patients and family. By requests to assist dying. Who see the suffering. We need to be thinking as much about these professionals as the patient.

      It is particularly vital that if this passes sufficient resources are put in place to support these professionals. In the high demand area of nursing not much is in place now to help nurses confronted by this issue with some of the support limited to ” just tell them it is illegal and you will talk to the dr aboyt upping pain relief”. That is not good enough without this proposed Law.

      • red-blooded 3.1.1

        Mental capacity to make a decision is basically being intelligent enough to understand the concept of death, and presumably protects the mentally disabled, people who are unconscious etc. I think it’s drawing a long bow to see it as protecting people who are depressed or lonely and feeling like a burden (and whose feelings could be allieviated in other ways), cleangreen, below, describes his feelings when first dealing with his disability. Maybe someone in that situation would choose euthanasia, when over time they could develop other ways to manage and to find ongoing value in their lives. (cleangreen, I’m not presuming to comment on you in particular, just thinking about the kind of situation where I worry that a decision made at one point would cut off any other possibilities that couldn’t be foreseen at the time.)

        Of course, the fact that you and I see mental capacity so differently illustrates one of the problems with the bill as it stands.

        Again, I do support the aim of the bill, but I’ve got issues with it as it is currently drafted.

        • tracey

          It is not just mental capacity. They must meet multiple factors of which that is one. Do you think 2 to 3 medical practioners will view lonliness and feeling like a burden as qualifying criteria for ” unbearable suffering” and less than 12 months to live? I dont.

          ” Providing full information and evaluating the request

          This part of the bill is quite good, in that nobody can make a final decision on being assisted to die until they have been informed thoroughly of the nature of their condition, any other options for treatment or palliative care, the fact that they can change their mind at any time, informed of their rights both to talk to family, friends, etc… or not talk to them if they don’t want to, and there must be an effort made to ensure this person has not been pressured or compelled into the decision, in fact the attending practitioner is legally required to do this to the best of their abilities.

          There is good evidence that making people aware of their options for end of life care including palliative care, and having them make a decision in advance actually decreases both unnecessary treatment and suffering, and desire for more radical solutions like euthanasia in cases where an option for reduced suffering exists that doesn’t require an early death or simply dying due to giving up, so discussing these options with patients in general is good policy, and I welcome its requirement in this bill because where these methods of giving dignity to the dying are utilized at a patient’s request they are a much more preferable outcome for everyone. ”

          My hope is those opposing this will put energy into supporting the vulnerable. So come on Bill English, youve had 31 years maybe now you will work to support the vulnerable to thrive?

          • Matthew Whitehead

            I have confidence in most of our medical professionals, Tracey, but this Bill is so poorly drafted in some areas that it both ties their hands and makes them consider information that is thoroughly irrelevant to making this decision in a reasonable fashion.

            The Bill is very clear in the eligibility section that it’s only the patient’s decision about what is unbearable that qualifies them for eligibility, and that the evaluation is to establish eligibility according to the Bill. So essentially they’re restricted to only confirming that the patient feels their condition is unbearable, and they are not restricted to considering factors that are a direct or indirect result of their illness or condition in that evaluation. If a medical practitioner disagrees that the condition is unbearable but notes that the patient does feel it is, that does not disqualify them under the Bill.

            It does limit you to people who are in a terminal condition or have a permanent, incurable illness, true. But among those people, it is absolutely open to factors that are irrelevant to that person’s condition being a driver for their request. The only requirement is that these factors contribute to “unbearable suffering”- you could literally be depressed because you lost a family member as well as your illness, and that could make you request this service, and it would be a factor that had to be considered in the evaluation.

            Overall, very poor drafting. The evaluation should give medical staff the ability to make an independent consideration of what qualifies as “unbearable suffering,” not merely attest that the patient feels it, and they should be required to consider only factors related to their medical condition or illness.

      • Ross 3.1.2

        Exactly right, Tracey.

        In the other thread about this issue, I linked to an article which discussed the attitude of doctors and nurses. The conclusion was that doctors and nurses currently administer drugs, or withhold treatment, knowing that the patient concerned will probably die as a result. Some of these professionals may be breaking the law. They should not be in that position.

        Lets remember that Dr Harold Shipman murdered about 250 patients (maybe more). I am not sure he would’ve been able to commit so many murders had similar legislation been in place in the UK.

        • tracey

          Thanks for this Ross.

          • cleangreen

            I concur with you Ross & Tracey,

            This is a to swiftly produced bill with to many pitfalls for everyone.

            Let s go sit arouund n while we all can think awhile.

            Rushed bills often wind up being wrongly constructed as this bill is.

    • cleangreen 3.2

      100% Red blooded, we must hope for a better outcome here.

      After my chemical poisoning I was faced medicallly to revert to gentle less invasive “alternative medicine,” (IV’s + vitamins/minerals and herbs,) that the majority of the “conventional medical community” stll tries to avoid sadly as it was these “alternative” medications that 25yrs later that are taken now that is still keeping me alive and living in some resonable (isolated) lifestyle.

      before end life choices are made all other options must be available to us all to have a choice for our own use, not to be ‘excusively’ controlled by the medical ‘establishment as they are draconian souls who understand less than we give them credit for.

  4. Ad 4

    This is as big a decision as the abortion debate many decades ago, and has some of the same features. As usual, it starts off with the argument that the legal right to end people’s lives will be incredibly rare, extremely well thought through by everyone having to make a decision through it all, and incredibly well regulated, but the reality is different:

    I am aware that the Dutch experience with euthenasia has not been bad overall, but the amount of careful groundwork laid by the entire Dutch medical profession over many decades , prior to the legislative change, meant that they were ready to carefully regulate doctors and educate families about the moments not to prosecute doctors and how to properly regulate it. We are not comparable to the Netherlands on this issue:

    I want to know if my taxes will go to subsidising killing people. I want to know how much. If this is not a voluntary procedure, then it should not be legal. If it is a voluntary procedure, then no taxpayer funding should go to it.

    So this bill is being put to parliament with almost no support from the medical profession, and on the back of overwhelming opposition from the public to parliament against euthenasia only six months ago. What a damn insult to those who put their organisational force into it.

    I recommend people read this Parlliamentary Select Committee report that thousands of New Zealanders contributed to:

    It made no recommendation to go where this Bill is going.

    • tracey 4.1

      I want to know why Seymour will do more to assist a dying person than those full of life. I want to know why English is outraged by this Bill but has damaged more lives than this Law would take. He has stood by for 31 years and watched while the disabled are treated like dogs. Their benefits cut. The challenges with ACC made harder. Some are born with disability and some are aquired. If you were working when disabled you get 80% of your earnings. If not working or born with a disability or disabled by illness you get subsistence. If anything English has stood by while some people feel forced to contemplate that death is better than tge life they have.

      That is what I want to know.

      And where is the current govt on raising, significantly the standard of living of our most vulnerable.

      • cleangreen 4.1.1

        Well put Tracey,

        David Seymour seems to be a bitter resentful soul that cares very little of human life and any means to improve the quality of all our lives including the poor, disabled; sick and dying.

      • Rosemary McDonald 4.1.2

        “And where is the current govt on raising, significantly the standard of living of our most vulnerable.”

        Labour has always struggled to see those with disability or illness as equally deserving of support as those who were once productive members of society and have been disabled through accident.

        Look how Labour has been supportive of maintaining or extending ACC cover at the same time as ignoring or further disadvantaging those with impairments not covered by ACC.

        There have been pre- election promises by Labour on issues relating to non ACC disabled which some of us have been told by the current incumbents will take some time to be addressed.

        Some of us with long standing issues are seriously considering popping down to Welly when parliament opens in the New Year to remind them that we’re not dead yet and we expect them to at least listen to us.

        That’s if we can come up with the $$$ for the trip….

        • tracey


          Ruth Dyson presided over a sweeping policy to make even the permanently disabled have to be reassessed every year. The stress this put on the disabled and their families seemed to escape them.

          Ardern wants to champion children in poverty which is great but like low incomes few of our parties want to address our appalling treatment of the disabled.

        • cleangreen

          Good move Rosemary;
          Please let me know when you get ready as we may also join this delegation if we can.

          We have already in 2011 had our proposal for those with ‘other disabilities’ recognised under this UN Charter inside our own NZ charter document given to the UN panel in 2012. ‘see under article 8 ‘Other disabilities’ as part of the ‘NZ declaration of the rights of the disabled’.

          The Convention on the Rights of Persons with Disabilities is an international human rights treaty of the United Nations intended to protect the rights and dignity of …

          NZ has signed up to this convention.

          United Nations Convention on the Rights of Persons with …

          United Nations Convention on the Rights of Persons with Disabilities. … United Nations Convention on the Rights …

          So New Zealand’ has international obligations now.

          Politicians need to be reminder not to discinate against us with cronic disabilities that are not cobvered under present health agencies or ACC to comply with the mamoranding of understanding the Government signed at the UN in 2012 to not disciminate against all those persons with disabilities under the UN Convention on the Rights of People with Disabilities

          I wrote a blg two days ago about infringements against those of us with disabilities and sonme bloggers were unaware of our rights to “dignity” and other considerations. it seems that the general public are yet to understand we with disabilities have rights to be adhered to under the UN charter of disabled human rights. This is our cornerstone protection document now as Australia has confirmed this also.

        • cleangreen

          Yes Rosemary we would be keen to join with you in the trip to Wellington too if allowed.

          We assisted changes to the NZ Government submission to the United Nations Convention on the Rights of Persons with Disabilities.


          New Zealand ratified the Convention

          we included in their submission in artilce 8 a addition of “other disability issues” where some of us are not currently recognised by the NZ medical ‘establishment as Austrlia, Canada, USA, Germany, Denmark and others do at present so this may help our cause to be given the ‘dignity and respect for services’ we are entitled to under the Disability convention now.

          Let us know when you are arranging the trip to Wellington please with some notice.

        • Matthew Whitehead

          Yep. It’s one of Labour’s big ideological holes IMO that rather than viewing work as something people do to effect positive outcomes in society, that work is somehow a measure of the dignity of a person in general. It’s a pathological attitude that leads to unjustifiable stigma against people who absolutely want to live in ways that will have them participate in and enrich our society, whether it’s paid work or not.

    • cleangreen 4.2

      100% Ad.


    • tracey 4.3

      Did you feel the same way about the overwhelming public opposition to repealling s59 of the Crimes Act?

    • Olwyn 4.4

      Nothing in the few months since this bill was last introduced has altered the …very complicated, very divisive, and extremely contentiousnature of the issue, and you have to wonder why it is being repeatedly thrust upon us.

      While I appreciate the careful work Matthew has done in outlining the holes in the bill, and suggesting amendments, there is a larger question as to whether our institutions are currently capable of holding to firm safeguards that are anything more than defensive paper trails. A society that is under continuous pressure to privilege expedience and usefulness above all things, with a few sentimental values thrown in, cannot be trusted to put these concerns to one side when considering matters of life and death, rendering any safeguards rather flexible. And as Tracey points out, people who lack the status and resources to fight back are permitted very few meaningful safeguards in life, and questions of consent are very hard to settle once a person is dead.

      I do wish that progressives would see that their cherished ideals do not reliably play out under predatory capitalism in the same way as they might under a genuinely inclusive social democracy.

      • weka 4.4.1


        Until we decide as a society to value people not money the risks will remain higher. I support euthanasia in principle, but I don’t trust the state or our political culture/processes to get this right just yet.

        • tracey

          Me too

        • Draco T Bastard

          It’s not fixed in stone. If the legislation isn’t working as well as it should be it can be changed and amended.

          But, IMO, we do need to start somewhere rather than just saying that it’s too hard.

          • tracey

            And if the medical profession consider it unclear one of their bodies will quickly seek a court intervention to define terms?

          • weka

            I don’t think it’s too hard. I think that we should be broadening the conversation out to look at what the risks are. Rosemary’s comments should be highlighted (and offsite, what disabled people are saying), and we need to understand those things in the context of 35 years of neoliberalism. Yes, legislation can be amended, doesn’t mean it will be, or that the people in charge at the time are working in our best interests. I wouldn’t have trusted Key’s govt to get this right for instance. I don’t even trust Ardern’s.

            We need a big conversation in NZ around vulnerability and disability and what kind of society we want. This seems like an ideal time.

          • Matthew Whitehead

            This is my position too- there are people who really, really, want and need the control and dignity over their death that this Bill will give them, and it’s not okay to not try to do this right, and do it now.

            But we do need to look at the bits that some people are saying “too hard!” about, and come up with reasonable solutions before we can proceed safely. While this is a bill that could change our culture about death and make it much more healthy and dignified in some ways, it comes with enormous risks if we set it up incorrectly.

            There are also big concerns among Māori groups, who talk about the concept of euthanasia being foreign to their culture. Sure, Seymour says that there’s majority support among Māori in his polling on this issue, but that could absolutely simply be the influence of colonization. That’s something we need to consider carefully before proceeding, too.

            • Psycho Milt

              There are also big concerns among Māori groups, who talk about the concept of euthanasia being foreign to their culture.

              Given that the bill is about voluntary euthanasia, there’s no issue. Anyone who feels voluntary euthanasia is foreign to their culture presumably won’t apply for it. And if they mean involuntary euthanasia is foreign to their culture, well it’s foreign to ours too.

            • Draco T Bastard

              There are also big concerns among Māori groups, who talk about the concept of euthanasia being foreign to their culture. Sure, Seymour says that there’s majority support among Māori in his polling on this issue, but that could absolutely simply be the influence of colonization. That’s something we need to consider carefully before proceeding, too.

              There is absolutely nothing we can do to save Māori Culture in the way that it was. Culture changes all the time and, when confronted with another culture, changes even faster.

              Yes, I’m sure that Māori culture didn’t have euthanasia. Many cultures didn’t including that which we’ve brought from England and other European countries.

              None of those cultures had the capability of keeping a body alive for 15 years despite the person being, for all intents and purposes, dead. Instead, when some one got sick, they just waited for the natural course of events which would probably only take a few days and of which there was nothing that they could do about it.

              Our new capabilities means that we have to pretty much ignore previous culture. If we continue to try to hold ourselves in the 19th century then we’re not going to come up with solutions to the problems that those new capabilities have bequeathed upon us.

              EDIT: and what PM said.

              • Matthew Whitehead

                Yeah, I’m just saying it’s something we do need to be sensitive to in this debate that we are potentially engaging in some colonialism here, and we need to listen to Māori voices in this debate and engage constructively with their concerns.

                I think you’re right that the lack of euthanasia was likely due to different living conditions and that it’s not fundamentally something we’re imposing as European values so much as something that has become necessary to consider due to the conditions modern New Zealanders live in, but I think we do need to be open to the possibility that we’re wrong in that conclusion, or that the conditions modern New Zealanders live in are themselves an imposition of colonialism. Cheers.

      • tracey 4.4.2

        I agree with much of what you say. Seymour wants to honour those dying but fucks over many of the vulnerable who are alive. English is morally outraged but has stood by and more recently presided over the degradation of the lives of the vulnerable living.

        If we are not prepared to value the living and their right to thrive why are we moving toward the right for the state to help end lives?

        I support the notion of the right to end our life. I support the need to support the medical professiionals who are already confronted with this issue daily. And I plead with our society to honour our vulnerable and accord tgem the right to thrive. Lets do the last 2 before the first.

      • Olwyn 4.4.3

        I am not, on principle, in favour of euthanasia, though I am aware that mine is but one position among many, that there is often a fine line between passively allowing someone to die and speeding up the process, and that situations do arise upon which one would have to be callous to pass judgement. In cases like the latter it is within the capacities of the courts to be merciful rather than punitive.

        But I am very much opposed to a codified system of euthanasia being introduced to a country that tends to be remiss about safe-guarding people it does not consider useful or valuable, and that lacks the infra-structure to firmly uphold its claimed safe-guards. We cannot even maintain safe work places, and rarely punish those who disregard workers’ safety, even when death results from their disregard.

        This was meant to be an answer to Weka, but I struck the wrong “reply” button.

        • Matthew Whitehead

          See, this is why I submitted that the bill shouldn’t proceed unless it gets a signoff from the disability community more broadly. (don’t think that’s explicitly in the post anywhere, but it bears mentioning) They are key stakeholders who need to be convinced that this Bill will be safe for them, and if there are any unaddressed concerns they have, that’s a sign that both Labour and the Greens should withdraw support from the bill as a bloc.

        • weka

          If we were a compassionate society that did look after vulnerable people well, would you support euthanasia legislation in principle?

          • Olwyn

            As you can see, my position is a nuanced one, but probably not, because I would still have an issue with the codification, which would invite the search for ways past it, if someone doesn’t want Granny but does want her house. I also worry about people missing out on valuable last moments, or perhaps changing their minds. What if, with a sound mind, you made a living will that included a request for euthanasia, but found yourself enjoying life in a doolally state and decided against it? Which “you” would have the last say?

            However, as I have said, I do not regard my own position as the only possible one, and am not hostile toward those who don’t share it. And I would be far more at ease with it in a society that treated vulnerable people well, and also, I would add, had the capacity to uphold its own safeguards and treat them with utmost seriousness.

            • weka

              Nuanced is what is called for imo.

              I think if we were a different kind of society there would still be risk, but much smaller and probably worthwhile when put up against other people’s suffering. This is the sharp end of it that lots of pro people don’t like talking about. The fact that there will be mistakes and should we allow it anyway give the benefits elsewhere?

              Is there a proposal to allow living wills for euthanasia? I think the Act would still require medical agreement and consultation etc, so no matter what you had said previously at the time you would still need to be considered competent to make the decision.

              • Matthew Whitehead

                I think having a living will that prompts doctors to approach you about the process under predetermined circumstances is a great idea.

                I also agree that there are concerns that we have the wrong sort of structural attitudes in our culture for euthanasia. I don’t view this as an insurmountable obstacle, so long as the process and the people involved aren’t coming from that place themselves, and are set up to avoid it being taken into consideration.

                • weka

                  There’s no way to guarantee that the people involved aren’t coming from that place including doctors.

                  It’s not just about relatives wanting to bump off their loved ones stuff. I’m thinking about the people whose lives are so shitty they will want a way out sooner rather than later and who fit the criteria for assisted suicide. Shitty not simply because they are in pain and dying, but because they’ve been unsupported across their lives and now they have a way out. That’s the stuff that’s underpinning some of the tension in this debate I think. NZ treats some people so badly they’d rather be dead.

                  • Matthew Whitehead

                    Yes, I absolutely agree with you. That’s why I think the legislation should require those evaluating a case to consider only factors relating directly or indirectly to the condition or illness that is supposed to be the cause of their suffering, and not other factors. (ie. depression is relevant to whether you are suffering unbearably if you are depressed because you have a limited time left to live, or because you’re constantly in pain. It’s not relevant if it’s because your dog died, or your family have devalued your existence, even though you have a legitimate reason to feel bad in all three cases) That way, if they start approving end of life applications on other grounds, like you’re pointing out, we can have SCENZ or whoever say to them “whoah, hold on, what you’re doing here looks medically negligent and non-compliant with the law, you need to stop or someone might charge you with a crime.”

                    I don’t think we’ll completely eliminate these factors because potentially people could lie and omit them from written reports or whatever and end up getting a second evaluation that agrees with them by chance. That’s absolutely a fair criticism of the bill. I think having one or two independent checks would be a sufficient safeguard if the person requesting an end of life option also appointed an advocate who had the power to stop the process as well and was present for both evaluations and the person being given lethal medicine, because they would be able to take into account whether they thought that the people involved were making a biased decision.

                • One Anonymous Bloke

                  Weka’s right, Matthew. Take the last nine years: how can you compensate for the effects of the National Party on people’s will to live?

                  • Matthew Whitehead

                    Weka’s usually right, and I pay great deference to her opinions. 😉 I just don’t think her being correct with her concern means we can’t structure a bill in a way that makes it difficult or impossible for her concern to actually result in an unjustified suicide. This bill is not yet that bill, but I think it could be, if the government parties put in the effort to reform it.

                    Good quip though, lol.

                    • One Anonymous Bloke

                      a way that makes it difficult or impossible for her concern to actually result in an unjustified suicide.

                      Health outcomes, including mental health, and life expectancy, don’t just correlate to poverty, but also to the GINI; inequality affects the wealthy too.

                      That suggests that everyone born or living in NZ between 1984 and the present is more likely to seek assistance in dying than a hypothetical ‘control group’.

                      We can already see this tendency in the suicide statistics.

                      In these circumstances, it’s easy for the result to be “unjustified”.

                    • Matthew Whitehead

                      I agree statistics can indicate causative relationships like the one you point out, although I would caution that suicidal behaviour, including inappropriately seeking to use the proposed bill, is only more likely under those statistics, not guaranteed. The determinants of suicidal behaviour are a little more complicated than that, of course, not that they don’t exist within that group in larger numbers.

                      My point is that a well-designed process should have the health professionals taking into account whether a person’s reasons for assisted dying are related to their illness or medical condition or not, and only those ones reasons that, taken as a whole, genuinely constitute extreme and suffering and are related to their illness or condition should qualify them to go ahead with the process.

                      If we have the law set up that way, and on the whole medical professionals involved are well-trained and sensitive to how to carry out this process in a matter that is caring, professional, and respects the safeguards mandated by law, then I suspect we’ll avoid the pitfall you seem to be anticipating. Right now, the law does allow this sort of thing through, but I’m confident that there will be sufficient opposition to it if by the time it’s through select committee it hasn’t been tightened up sufficiently.

      • Matthew Whitehead 4.4.4

        Yeah, this is actually one of my points against the bill in the post, if you don’t get overwhelmed by the wall-of-text: right now the only safeguard is that you get at least two independent evaluations before the process goes ahead, everything else is paperwork that keeps track of who’s responsible.

        This does nothing to ensure that nobody is administered lethal medication against their will, which should be the very real concern in giving this ability to medical practitioners, especially in the context of prior malpractice in certain areas, like involuntary electroconvulsive therapy. Hence why I recommend a nominated observer by the patient (which could be either a family member, friend, or just a volunteer they picked out and trust who is obliged to honour their wishes and privacy requests) must be present and have the power to stop or pause the process at any time on their behalf.

        And yes, I do agree that the structural pressures you list will be present in many people, if not all, who are eligible for the process created by this Bill. The Bill should rule out any suffering caused by those attitudes, either explicitly or through the way its eligibility provisions are structured. It currently does no such thing, and that too is deeply worrying.

        • Psycho Milt

          This does nothing to ensure that nobody is administered lethal medication against their will…

          That does seem like one hell of a gap for a voluntary euthanasia bill to have in it. Ensuring the “voluntary” part is one of the core tasks of such a bill.

          That said, I wouldn’t want it to be so restricted that you couldn’t create living-will stuff like “If I’ve been in a vegetative state for X weeks, please see me off without further ado.”

          • Matthew Whitehead

            Well, Seymour has essentially made a lot of good active chances for people to say no. One of my recommendations in my submission is that he instead restructure the wording so that failing to say “yes” is treated as a no unless and until the patient does manage to say “yes,” so that we’re always looking for active consent. Right now he doesn’t even have a provision in the bill for what happens when someone is offered the choice but doesn’t give a clear yes or no.

            To be fair, if people are genuinely following the law in good faith and each one involved is acting as an individual, then Seymour’s structure will work. What it’s not well-designed to prevent is a culture of collusion to kill people without explicit consent, such as when, say, two doctors both know each other and have worked together in the past, and one of them gets assigned to independently review the other’s patient. If both doctors have, say, a dismissive view of the disabled, then they might unethically pressure the person towards killing themselves, and report that they followed the bill. In this situation, it would require someone accidentally barging in to them doing so in order to have any evidence of what they’d done, and to either prevent the killing, or to hold them responsible for murder. Requiring the patient to appoint an advocate who attends these sessions to ensure everything is above-board before the formal evaluations can start would prevent this.

      • cleangreen 4.4.5

        Well said there Olwyn.

        Above all else we need to protect life.

        No Medical person or agency or service, has the right to decide who should live or die.

        Even those who murder found gulty in a court of law is able to decide any death without a legal challege.

        • Psycho Milt

          No Medical person or agency or service, has the right to decide who should live or die.

          Er, yes. Why do you point out this truism? Has someone suggested they should have that right?

        • Matthew Whitehead

          What are you even trying to say here, Cleangreen?

          This bill, if followed, would put the decision broadly in the hands of the patient. There are some technical issues to work out to make sure that this intention is followed through with in reality and that the safeguards are accurate, but nobody is actually proposing that we let anyone get away with involuntary euthanasia, it’s just a question of whether the bill is well-written enough to prevent that.

          (I think it will be with staff who are acting in good faith, what I’m worried about is places where the staff might act in bad faith then be assigned an independent reviewer who also acts in bad faith)

    • Ross 4.5


      I’d say that there’s plenty of support for this Bill from the medical profession. I dont think many enjoy watching patients suffer.

      • red-blooded 4.5.1

        Plenty of support for some action on the issue of euthanasia doesn’t necessarily equate with supporting the bill as it now stands. I’m with the Greens on this one – send it to select committee, give people the chance to have an input, look to plug holes and improve definitions, then see whether it’s been rendered fit for purpose or (if the basic concept has support) use it as a learning experience towards drafting a better bill.

      • tracey 4.5.2

        It is very hard for some in the medical profession to be truly honest about what already happens for obvious reasons.

      • Matthew Whitehead 4.5.3

        There is support from some parts, and opposition from others.

        Naturally, palliative carers are against it. They want to think their option is for everyone, which is a little arrogant in my view, although understandable- what I actually like about this Bill very much is that it steers people who didn’t know about the other options towards them instead if it meets their goals, which is good policy and good medicine.

        My girlfriend (who has just qualified as a nurse, and doesn’t follow politics) was actually very surprised that there were medical people against it, though, so there are definitely many who are for it. I think the thing is, they are reluctant to submit as much because there is some very real stigma against openly identifying yourself as a supporter, not least because people might start looking at your patients who died to see if you potentially euthanized any of them, and even if you don’t hold with that sort of thing, that doesn’t mean someone won’t get the wrong idea.

    • Matthew Whitehead 4.6

      I think the point about the infrastructure and preparation for this being in place is a good one, Ad, and another reason to proceed with caution even if we sort out all of the kinks in this law. It’s a reasonable point to make in a submission, if anyone wants to, I’d say- start the bill in shutdown mode, and give SCENZ and/or the Minister of Health the power to determine when the necessary infrastructure is in place to let it proceed.

      I disagree with the idea of allowing these controversial procedures, like euthanasia and abortion, but withdrawing all taxpayer funds from them. That’s not freedom of conscience. That’s economic boycott.

      My taxes go to plenty of things I don’t like, (and those things vary from petty objections, like subsidizing rugby, to moral and economic ones, like subsidizing dairy irrigation) but we decide democratically where they go, and if you look at the funding amounts, you can absolutely argue that people who do support these things are the ones funding them, given how small an amount of government money goes to it. If there’s a huge bloc that agrees with you that boycotting our collective money to euthanasia or abortion is okay, and we should restrict it only to people who can financially afford it themselves or get the help of a private charity, then we’ll have to accept it, I guess, but what you are doing there is not conscientious objection, you are trying to deny people access, and you need to own up to that when you call for it, because without taxpayer funding, there will inevitably be a shortfall of people who can’t afford these services, but would like them.

      This is the same thing as doctors claiming they have a right not to inform their patients that there are other people who will perform an abortion for them when they object to doing it- it is an attempt to deny people access.

  5. One Anonymous Bloke 5

    We have a three tier health system: private, public, and inaccessible.

    Citizens for whom the system is inaccessible – whether because of underfunding, long waiting lists, or low income, necessarily experience worse health – often throughout their lives. You can work out how that becomes relevant to this bill on your own.

    When user pays is dead and buried, and healthcare is genuinely accessible to all, it might be time to have this conversation.

  6. adam 6

    And like that we hand the state the power to regulate killing of its citizens.

    What next I wonder, what next…

    • tracey 6.1

      In so many ways they already do and in other cases we torture them first… but it isnt a Law so some turn a blind eye.

    • No we don’t and you really need to stop with the lies.

      • adam 6.2.1

        You need to get a grip on reality, stop and think beyond your own experience for two minutes.

        But then again you thinking the state killing people for economic reasons is acceptable, so I’m not sure you are the best advocate for this bill.

        • Matthew Whitehead

          I gave DTB a pass on his reply hoping it wouldn’t get any disagreement, (and because I know he has a tendancy to try and state his position quickly in his first reply and then follow up substantively later, which is a great time-saver where all respondents agree) but I generally would prefer that people disagree respectfully in my posts and actually talk substantively about their opinions.

          Draco has strong opinions, like most authors here, but he is not generally one to refuse to think about others’ perspectives, if they articulate them clearly.

          What you’ve done, Adam, is just given short lines about your own opinion, not made any substantive argument for it. Perhaps try going into more detail about what your problems are, and why you think this bill will “kill people for economic reasons’ before you accuse an author on this site of being unwilling to listen to your perspective when he has a great history of replying in detail when reasonably challenged.

          I’m at least somewhat a critic of this bill despite supporting its aims, and even I think it’s very unlikely that people will succeed in killing people for economic reasons in any significant numbers from this bill as it is now, so I think you’ll need to make a strong case if you want someone like Draco to change his mind.


        • Draco T Bastard

          The state won’t killing any one if this bill, or one like it, goes through.

          EDIT: Clarify: This bill does not give the state the right to kill people.

    • Matthew Whitehead 6.3

      If someone asks you to help them die in a way they choose, is that really killing them, Adam? Is it not instead giving them control and dignity over their body and their life?

      This is bill largely focuses on terminal patients and people with conditions that are untreatable but lead to suffering. The intent of the bill is good in my opinion, what I’m worried about is the implementation. This bill rushes ahead to allowing practitioners to administer lethal medication at a patient’s request before we’ve even had a regime that lets patients take the medication themselves. That is the appropriate starting point, and it is a good safeguard against people breaking the law and killing people who don’t want to die.

      The state already has the power to regulate things that can kill its citizens, by the by. Insufficient resources in health can kill citizens. Insufficient resources in welfare can kill citizens. This Bill isn’t some new moral ground we’re treading on to in that respect, and we’ve debated this issue twice before, too, so it’s not new in that respect, either. What is new is that there seems to be a will, in principle, to go ahead with this, the questions about whether we should from Parliamentarians are largely practical ones at the moment.

    • The state already has and always has had the power to regulate killing of its citizens. Parliament is sovereign.

      • adam 6.4.1

        And you don’t think that is a problem?

        • Matthew Whitehead

          You don’t think that sometimes we will need to regulate when it’s appropriate for people to live and die? We already have a military, that’s absolutely a state-sponsored organization that has authority to kill people. I’m opposed to war on principle in most cases, and even I think that the state needs to have the power to have one.

          Likewise, I might oppose the state killing people, but I don’t think that’s what this bill is, in principle. It is giving ordinary people in painful situations the power to decide the manner of their own death, taking away the threat of the state arresting people who help them in order to restore their autonomy and dignity. My objections are entirely practical.

        • Psycho Milt

          Well, it may be a problem, but it’s not really a relevant problem to the post at hand, given that no involuntary euthanasia bill has been presented to Parliament

  7. One Two 7

    ‘The NZ Experiment’ continues..

    The chemical companies will maintain control by leathal death while simultaneously ensuring that cannabis and natural remedies are sidelined for as long as possible, as broardly as possible..

    For those commentators in this thread who don’t or can’t reconcile the government /parliaments position on these two topics

    Captured and controlled by industry is the reason…

    • Matthew Whitehead 7.1

      You’re going to have to explain your theory a bit better than that, One Two. While I have big objections to this bill as-is, it’s clear that it is written in such a way that there is no profit incentive to it, in fact killing people for profit would nullify the immunity, ie. make the people involved liable for murder.

      • One Two 7.1.1

        Hi Matthew, I appreciated your article, and thought it was objectively written

        I see it like this…

        NZ Govt takes its medical directives largely from the US/UK/CANADA

        The US has industry lobbyist dedicated to maintaining control of chemical drugs over natural plant based ‘medicine/treatments’, is well documented…

        The chemical pharmaceutical companies have a conflict of interest between discussions and policy around life/death…they operate on both sides, which make the explanations more detailed/complex than I will go into here..

        Simply, and in my opinion, the government of NZ has an ‘easier’ option by not pissing off its corporate sponsors, via the ‘assisted death’ legislation, than it does with the ‘medical marajuana’ legislation..

        Medical weed progression will be closely monitored and curtailed by the chemical companies, which can be witnessed with the watering down of the bill…too much is at stake to the chemical industry to stand by passively..

        That these two bills are presented simultaneously is not luck, nor is it an accident

        • One Anonymous Bloke

          Does David Clark meet David Seymour in the secret office where they run everything from, or do they just text one another?

        • Matthew Whitehead

          If this were being driven by powerful corporates, One Two, why would the National Party oppose it?

          • One Two

            Ask ‘The National Party’…

            It’s convenient to have the bill put forward by Act, as it is convenient to have a mock showing of ‘counter balance’, this time by the NATS

            In any case, I posted a number of comments on another thread of the same subject in recent times…

            My position is that NZ as a nation is not equipped/mature enough to having this discussion…

            We are long way short of being ready, yet here it comes..

            It’s not going away, and will become ‘law’ sooner than later..with or without National Party support

            They already know that though…

            • Matthew Whitehead

              The Nats definitely have real opposition to this Bill, One Two. One of the provisions that Bill English got shouty about is something his wife went to court to prevent being policy on abortion- he’s not inventing his personal anger about this bill, he genuinely has problems with it. (This is the conscientious objection clause, which I praised in the main post)

              The nats are largely opposed because there is no significant economic impact, so they’re gonna conscience vote based on whether they’re liberals or conservatives, and the liberals will vote based on whether they think the bill is genuinely workable, wheras the conservatives will oppose en masse because of moral objections.

              I’m not opposed to thinking that there are political conspiracies out there to help enrich large corporations. I’m in fact sure that sometimes this does happen, even in New Zealand. But we should be careful about veering in this direction in every case, and I think in this case if you’re thinking it’s a corporate conspiracy, you’re saying that Labour, NZF, and the Greens are all in on it, which is a little ridiculous- Labour might be, but NZF and the Greens are almost reflexively going to be against anything like that.

              • One Two

                every case…

                Nope, and that’s not what I’m saying about the political parties…

                I’ll say it about the entire system though..captured by big interests and debt!

                Nothing is ridiculous, except the ruling out of a serious, in depth conversation …which I don’t believe will’s not allowed in Nz..Why do you think that might be?

                People are free to believe in the political system and frameworks all they like…

                I look at the actors, the synergies between them..and past actions of those involved, and those that are likely involved..

                Then I look examples abroad to see where the direction which the nz experiment will take..then I lower the bar…

                • Matthew Whitehead

                  So, you’re saying you have no actual evidence, even circumstantial, behind your allegation that this law is all about corporate profits? Because that’s sure what it sounds like.

        • solkta

          “That these two bills are presented simultaneously is not luck, nor is it an accident”

          So the Act and Labour Parties are in conspiracy?

  8. While there is provision to avoid active coercion, there is no provision to rule out contributory effects from feeling devalued, or a burden on the community, that arguably have been observed in countries that allow euthanasia, and whether these could be termed “unbearable suffering.”

    I don’t see any way a law could cover people’s feelings. Those who require a great deal of care right now are open to feeling devalued or that they’re a burden on their families/society, and there’s no sign of an epidemic of non-assisted suicide. What’s the mechanism by which the possibility of assistance to kill yourself makes you suddenly feel devalued or a burden on society if you didn’t feel that way already?

    • Matthew Whitehead 8.1

      Actually the law as written makes someone’s feelings a prerequisite for them to qualify. You must FEEL that you are in unbearable suffering, and the evaluations must agree you feel that.

      • Psycho Milt 8.1.1

        I guess “cover people’s feelings” is the wrong phrase. I’m all for laws that say “If you feel like you want to do this, far be it from the government to try and stop you.” Of less value are laws that say “Well, we can’t let you do this thing you want to do because it might make third party X feel bad.”

        • Matthew Whitehead

          As someone with a lived experience of mental health problems, the subjectivity of that test worries me greatly. It is absolutely possible for people to have feelings that are completely out of line with reality. I think what the patient feels is a valid barometer for starting the process, but the evaluation that they be allowed to continue should test if those feelings are grounded in the reality of their circumstances, rather than unrelated poor mental health, or outside social pressure, feeling devalued and stigmatized, etc…

          I think there is some risk in doing so that people with genuinely unbearable pain or suffering may feel like they are being asked to prove it, but I think that’s a reasonable ask before we have someone assist them to a death of their own choosing.

  9. Finally, there is no separation between terminal or degenerative disease and disability- in fact the requirements can be read to explicitly include any sort of irreversible disability that involves progressive decline in capability, and this too is poorly defined and could broaden in definition over time if not spelled out explicitly in the Bill. There are very real concerns that this Bill will allow for disabled people to be euthanized…

    You seem to be arguing here that the disabled must be excluded from eligibility for voluntary euthanasia, or disabled people could be involuntarily euthanised. On the face of it, that looks like a non-sequitur to me – what’s the logic for your conclusion?

    • Matthew Whitehead 9.1

      I think we need to tread very carefully around the intersection of euthanasia and disability, and this Bill shows no signs to me that Seymour has even considered this issue. There are hugely complicated histories between the disability community and medical practice. I mentioned involuntary ECT earlier in the thread as an example, and there will be many who will worry that this bill will be abused and people will be killed without their consent, or pressured into taking this option, or that it will create a culture where we devalue people with disabalities even more than we already do. These are all valid feelings given the history of the community, and the Bill needs to address them. I think it has been intended to be cautious, but problems in the drafting mean it isn’t as cautious as it claims to be.

      I think we need to be very careful in opening this bill up to people who aren’t already dying that we do so only in situations where their conditions could genuinely be viewed as unbearable and are actually incurable, not simply people who feel that way due to factors not related to their condition, and that we don’t get any sort of definition-creep into euthanising people whose conditions are merely challenging but can be managed and deserve agency and assistance, not stigma. I am not categorically opposed to it, but I think it is a cause for concern as the bill is currently drafted, and I think any concerns that haven’t attempted to be addressed in this area should be a deathblow to the Bill once it’s at second reading, and that all of them need to be sufficiently addressed by third reading.

      • Psycho Milt 9.1.1

        I’m probably more at the ACT end of the scale on this, but I think there’s only so far that medical authorities should be allowed to overrule the wishes of their patients. I can understand the idea of wanting doctors not to just shrug their shoulders and kill somebody who’s depressed if they request it, but if I was to become a quadriplegic and didn’t fancy continuing living, I wouldn’t want doctors refusing assisted suicide on the basis that being a quadriplegic isn’t fatal and what kind of example would that set for the other quadriplegics? The basis of the bill has to be that people of sound mind get to decide for themselves.

        • Ross

          The assumption might be that droves of people with a terminal illness will want to kill themselves. But I suspect the vast majority will choose to carry on living and won’t take up the option of assisted suicide. As David Lange once remarked regarding homosexual sex becoming legal, it’s not compulsory!

          • Ross

            we don’t get any sort of definition-creep into euthanising people whose conditions are merely challenging but can be managed and deserve agency and assistance, not stigma

            That is surely up to the individual? Personally, I dont like the idea of train drivers having to find another job because they’re sick of watching people walk in front of a train.



            • Matthew Whitehead

              The thing is, Ross, just because something is up to the individual doesn’t mean they’ll necessarily be in their right frame of mind when the decision is made. This bill currently only requires they be mentally competent- it doesn’t specify that people evaluating someone are allowed to rule them ineligible because of temporary emotional distress or other factors. A judge might rule that way if a case ends up in court, but it wouldn’t be due to anything explicitly written into this law, so we’d be relying on judges finding a legal justification for common sense, there. I am hoping for this to be addressed in Select Committee.

              I don’t mind people ending their lives if they’re suffering and that’s truly something they would want regardless of what happens in the future. But there are very real implications of mental health and disability that this bill doesn’t seem to consider in its drafting, likely because it’s David Seymour writing it and he’s probably never met anyone willing to talk to him about either topic.

              For instance, a bipolar person like Stephen Fry might well be highly mentally competent, but if he had a terminal illness or a qualifying medical condition under this act, it’s possible he’d have a depressive period, and might be able to go through this entire process and kill himself if the law doesn’t allow for the people evaluating him to take that into consideration. Isn’t that incredibly dangerous, given that he might in fact have wanted to continue living once he came out of that period?

  10. greywarshark 10

    I’ll be looking at what my submission should say after Christmas and will read every one one of the comments in this post. Excellent post and many thanks Matthew.

    • Matthew Whitehead 10.1

      Glad if it helped you. I basically used it to draft my own submission, although since I sent it in early, I’ve since had some thoughts of other things I could have said on it. Go figure. Still, someone will likely submit on most of them.

      Enjoy your holidays!

      • greywarshark 10.1.1

        Matthew W
        Can people put in more than one submission – provided it is not just repetitious?

        And vice versa about holidays to you.

        • Matthew Whitehead

          I think probably the best way to ensure you can get your say on anything that comes up is to ask to appear before the committee. (if you are in Wellington) I’m pretty sure it’s set up so that you can’t revise your submission once it’s sent so as to make it easier on Parliamentary staff to process submissions.

  11. One Two 11

    Talking about ‘legally enabled killing’…

    ….as a species ‘we’ could hardly claim that we understand how to ‘live’…

    • One Anonymous Bloke 11.1

      If you’re a member of this species, how can you tell? If you don’t know how to live you don’t really know that you’re not living. Even when I’m out of body, or ‘in the zone’ if you prefer, I’m still a member of the species.

      Further, since you’re ignorant of how to live, how can you tell that everyone else lacks the information?

      Edit: these are rhetorical questions, by the way.

    • Sabine 11.2

      well we are already killing ill people. We don’t have the beds to heal them in our hospitals when they need them.
      but hey, that is ok i guess, its the ‘self determination’ that our more authoritarian moralistic fellows have an issue.

  12. cleangreen 12

    What we see here after all the efforts of all respondents shows that there is great “disquiet here at the throught of anyones life being ended by a decision made by regulatory authorities and/or health agencies/facilities rather than the person/persons involved here.

    Our feeling is as always it must be the up entirely to the family first and the person whom is under the subject of “end of life choice’ that must rule the day.

    otherwise we will potentially have a contion see as ‘summary executions’ one day by authorities with their vested interests placed before ours.

    • …there is great “disquiet here at the throught of anyones life being ended by a decision made by regulatory authorities and/or health agencies/facilities…

      Well, that’s unsurprising if there are people in every discussion on the subject who conflate voluntary euthanasia or assisted suicide with “a decision made by regular authorities.” You bet we’d feel disquiet at the prospect of those people making those decisions, but that isn’t what’s being proposed, so how about your thoughts on what is being proposed?

      Our feeling is as always it must be the up entirely to the family first…

      WTF? Where does that come from? Maybe you’re happy to hand over decisions about your life and death over to your family, but please don’t use the verb “our.”

    • Ross 12.2

      Some of those opposed to this Bill possibly also oppose abortion and gay marriage. Some people will forever be on the wrong side of history.

    • Matthew Whitehead 12.3

      And as flawed as it is, this bill does actually make sure the decision is absolutely in the hands of the person requesting to end their life. It does allow for a doctor to administer the lethal drugs, if requested, but only after the patient finally consents one last time.

      It does not, however, give any special rights to their family, (other than for the practicioner who processes the request to check if the patient wants to consult them about their decision) which I think is absolutely appropriate, as they might have very different views on this matter or be estranged, and a patient with a terminal illness or serious medical condition that qualifies for this process deserves their privacy, even if they’re ending their life. It might be heartbreaking for their family, but if they wanted to be involved in this decision then they needed to have made their family member feel like they could trust them with this information.

  13. Sanctuary 13

    “…Justice Heath allowed the move before a substantive hearing could be held.

    He found the High Court had jurisdiction to make the decision.

    But he also said the ethical and moral dilemmas involved in fertility treatment were not well suited to the courts.

    Justice Heath concluded the court could protect Ms Long’s right to approach the Ethics Committe…”

    The judge wisely concluded that moral and ethical decisions are not well suited to legal (and by implication legislative) solutions. IMHO, the same principle applies to euthanasia.

    • Ross 13.1

      I am not seeing the connection here. There is no legislation around taking sperm from dead people. If there was, I suspect there wouldnt have been an application to the High Court.

      You might recall that Ms Lecretia Seales applied to the High Court to make a judgement about her wish for assistance to end her life. The Court sort of passed the buck and suggested legislation was the answer. So here we are.

    • Matthew Whitehead 13.2

      Actually concluding an ethical question isn’t well suited to the courts when there is an available ethical committee is very different to concluding that it shouldn’t be legislated on. This is because courts must interpret existing legislation, so if there was no relevant law on the particular subject, (and I don’t think there was here) then an ethical committee is a much better place to hear arguments.

      Legislators, however, make the law, so have no such barrier. There is sometimes an argument that sometimes reforming legislation or making legislation is worse than the status quo, (I’ve heard people make that argument regarding abortion law reform) but that’s very different again to saying that Parliament isn’t suited to making those sorts of decisions, it is instead usually one to say we’re divided and that the law is likely to change backwards and forwards if people make decisions one way or another, or at least there will be a backlash of some sort.

      As Ross says, it is entirely appropriate for the court in this case to say any remedy would have to be handled by the legislative branch of government if the law is currently silent on a particular matter.

  14. Rosemary McDonald 14

    Posted this morning in the Herald….

    Now, for reasons which might become clear, I’m going to blockquote…

    “David Seymour should buy a Lotto ticket

    Something unusual happened in Parliament on Wednesday night of last week. Not the 76-44 vote in favour of the first reading of Seymour’s End of Life Choice Bill. That was entirely predictable.

    No, it was what happened next which suggests that Seymour is very lucky indeed.

    Seymour rose to move that the bill be referred to the Justice Select Committee which would have to report back within nine months. Just a procedural motion, right? Hmm.

    The extraordinarily lucky thing for Seymour is that all eight members of that committee had just voted in favour of the first reading. All of them.

    Call me suspicious, call me cynical, but that strikes me as … improbable. In fact, it’s a 2.6 per cent probability.

    Here’s the maths: 76 of 120 members voted in favour, or a 63.33 per cent likelihood that any individual would vote in favour. The likelihood that 8 randomly selected members all voted in favour is therefore 0.6333 raised to the power of 8, which is 0.02588, or 2.6 per cent between friends.

    So either Seymour is very lucky, or it wasn’t random at all. That it was in fact all arranged beforehand.

    Now, that’s maybe clever inside politics, but maybe it’s also not very clever outside politics. Because it’s going to raise the level of scrutiny of how the Justice Select Committee goes about its work on this bill. Is it going to be an open, transparent and fair hearing of all New Zealanders who want to have their say?

    When you come from a 25 per cent majority constituency (disabled people) who are alarmed to be directly in the loosey-goosey eligibility criteria cross hairs of this bill, open fair and transparent select committee dealings are minimum standard.”

    This is an opinion piece by long time disability rights activist and leader of the ‘Not Dead Yet’ campaign.

    All good so far?

    In typical Herald fashion they have embedded in this article a video clip from a pro – euthanasia commentator…captioned thus…

    “Bobbie Carroll, who has terminal blood cancer, fears how she will die if euthanasia isn’t legalised.”

    Wendi Wicks’ piece raises some very interesting points and no doubt the more parliamentary procedural savvy in our midst can deduce if she has valid grounds for concern.

    But christ on a raft Herald…up your frigging game!

    • Matthew Whitehead 14.1

      Rosemary, you’re ruling out that the fact they’re on the justice committee having a determination on their opinion about euthanasia.

      I would’ve guessed that it’s very rare for conservative MPs to be chosen for the justice select committee. Mostly, liberals of one stripe or another are more likely to be Justice spokespeople for left-wing parties, and if that trend generally holds true relative to the norm for each party, it would make SC members far more sympathetic to the bill.

      I’m not surprised at all that in this case he’s referred it to a committee that supports the bill at the moment. The question will be whether it comes out of the SC in a shape that will allow their colleagues to support it to second and third reading.

  15. gsays 15

    Thanks Matthew for this post.
    Enlightening and a great forum for discussion.
    Unfortunately wage slavery calls and prevents me from engaging at any depth.
    Cheers too, to the folk who have commented in a largely delicate fashion.
    Euthanasia doesn’t sit well with me, (greedy rellies, life ‘seeming’ to have lost quality, growth often accompanies pain, pain is inevitable suffering is optional).
    However very limited time and I feel better able to communicate the subtleties in the flesh.
    Thanks again.

    • Matthew Whitehead 15.1

      You’re welcome. I hope you enjoy your holidays, mate. Never apologize for having to focus on surviving or the family. That’s totally reasonable.

  16. Incognito 16

    Hi Matthew, you may or may not have heard of this story:

    It has a bearing on some of the issues that have been touched upon in this post + comments. The main point is, in my view, whether we can ever properly evaluate unbearable mental suffering when this is not only inextricably linked to the physical sensation of pain but also when mental and emotional suffering are, in fact, the major cause of wanting to end one’s life even in the absence of physical pain and/or terminal (physiological) illness.

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