'Medically assisted dying' might not be the way to go

Should New Zealand introduce a change in law to permit some form of "medically assisted dying'', asks David Tombs. 

The University of Otago's Bioethics Centre and St Paul's Anglican Cathedral have just finished a series of public talks called "Speaking of Life and Death'', where speakers offered personal perspective to explore the issue of euthanasia.

The discussion was part of a much wider public debate.

On February 1, the Health Select Committee concluded a consultation process on public attitudes to "medically assisted dying'', with a view to a possible change in law.

Those strongly in favour of a change in law include the Voluntary Euthanasia Society of New Zealand.

They point to polls that indicate a very high level of support for medically assisted dying among the general population (one poll showed 82% public support in 2014). They also present it as the compassionate option to prevent unnecessary suffering.

By emphasising rights, choice, freedom and compassion, those in favour of change receive a sympathetic hearing.

By contrast, those who are opposed to the change risk being seen as outdated and inflexible, and even uncaring.

Opponents seem to be unreasonably imposing their views and values on wider society.

As the Lecretia Seales case last year showed, as a society we are facing hard choices.

There are no easy answers or simple solutions to the issues raised in this debate.

Opinions on all sides need to be heard with the greatest respect, as they may be linked to very painful personal experiences.

A number of churches and church bodies took the opportunity to make submissions.

Although there are some Christians who support a change to the law, most churches are opposed.

Medically assisted dying by its very nature goes well beyond the free choice of the individual concerned.

The "assistance'' inevitably relies on actions by others, and most medical professionals are opposed to it.

Furthermore, the intended outcome will also have an impact on family, friends and wider society.

It is never just about a single individual.

Likewise, although compassion should be paramount for churches, there is a big question on how this is to be appropriately expressed.

Is it compatible with the intentional taking of human life, and what wider consequences on others might there be if this is legalised?

Church opposition to changes in the law reflects a variety of underlying principles.

For some, the biblical prohibition on killing is the key foundation.

This is often linked to a wider recognition of the sacredness of life.

My own reservations stem more from how we promote our human dignity, and seek the common good, and what unintended consequences there might be to a change in the law.

Would a change of law for very hard cases, such as Lecretia Seales, slowly extend and expand to cover a much wider range of cases, which undermine essential human values?

This is often called the "slippery-slope argument''.

Proposals for changes to the law usually include safeguards and controls that should prevent this slippage.

However, it is often very hard to maintain these in practice, especially when already vulnerable people are concerned.

The evidence from other countries suggests these concerns are well-founded.

Pressure can develop to liberalise and extend the provisions further by small increments.

If the guiding principle is choice, then it is harder to exclude some people from making this choice while others are allowed to choose.

Furthermore, without an absolute prohibition, it is easier to justify stretching (or even ignoring) the law in some circumstances.

Why deny someone their wishes on a legal technicality if their wishes seem clear?

People who stretch the law in this way are unlikely to have bad intentions - just the opposite.

They will usually be seeking to do good in a difficult situation.

They may feel that it is the spirit of the law, rather than the letter of the law, that matters.

Nonetheless, the cumulative effect of this incremental creep is likely to spread throughout society.

Public policy needs to address the common good, not just individual cases, no matter how difficult and painful individual cases might be.

The focus should be on society as a whole, with particular concern for those who may be vulnerable.

When the possibility of medically assisted dying exists for individuals who are well-placed to decide and want to take it as a free choice, it also becomes a much greater risk that others will feel expected to do the same.

Mechanisms and policies can be put in place to try to detect and prevent pressure and coercion from others.

Nonetheless, it is much harder to detect and enforce self-pressure if people think they should "do the right thing'' for the sake of others.

In light of this, I personally think a change of law should be opposed.

The slippery slope and the unintended consequences of medically assisted dying are too high a risk, and they need to be anticipated and avoided.

- David Tombs is the Howard Paterson Professor of theology and public issues at the University of Otago.

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