The euthanasia debate is heating up as the End of Life Choice Bill is due to have its second reading in Parliament this week.
In Canada, euthanasia has been for three years now. Dr Stefanie Green, a leading Canadian expert in medically-assisted dying, is in New Zealand and she explained on TVNZ1's Breakfast today how the country has centred the bill around patients' care.
"What this looks like is a celebration of life with friends and family around someone saying goodbye, having some closure and then a very peaceful, very quiet death," she said. "This is a patient-centred, patient-driven care – it must come from the patient themselves.
"There's no way anyone can ever ask for this other than the patient."
But Disability Rights Commissioner Paula Tesoriero expressed concern that patients may feel coerced by their families to choose medically-assisted death.
"The number of people involved in the disability sector who made a submission on this bill in New Zealand overwhelmingly opposed it because of the potential concerns for disabled people," Ms Tesoriero said in a joint discussion with Dr Green.
"International evidence shows that one of the top five reasons that people request euthanasia or assisted dying is precisely because they feel like a burden on their families.
Ms Tesoriero said she has multiple concerns about the bill, including its scope.
"I'm concerned that the safeguards are woefully inadequate; I'm deeply troubled by the fact that this conversation is taking place in the absence of having a wider discussion about adequate disability support services in New Zealand; and I'm equally troubled by the fact that it's very unclear what our Parliament will be deciding on this week," she said.
Dr Green said concerns around patients feeling as though they are burdening their families has been addressed in Canada.
"If a patient comes and says to me, 'Look, I’m a burden on my family, this is something I feel I need to do for the best for my family,' that's not an eligibility requirement," she said. "People raise it sometimes as an issue and we explain to them, 'That's not a reason to go ahead'. So that’s not a reason to have an assisted death – it's very clear in our country.
"Now, sometimes people say, 'That's very subtle, they won't come up and say that'. It's part of my job as a physician every day, in every way, to talk to people about what their real intentions are. People make choices, we offer them options, and it's part of my job and every clinician's job to make sure people have capacity to make choices, and that they're not being coerced in any way.
"This is a skillset that every physician has every day that they use."
Another concern that has been raised is the conscientious objection clause, in which physicians can object to aiding in medically-assisted dying. An open letter released yesterday was signed by over 1000 doctors who were against taking part in assisted suicide.
Dr Green noted, however, that "if there's a thousand doctors that don't want to do it, there's a thousand doctors that don't need to do it".
"I'm sure you can find a couple dozen that will, and so I think it's important to know there are physicians in New Zealand willing to do this work."
She added that while it is important to "support and respect" physicians' right to choose, they should not forget about their professional obligations in the process.
"They need to excuse themselves for moral reasons; they need to tell their patient they're not going to abandon them; they need to explain to the patient it's for a personal reason, not a system-wide issue; and they still have a professional obligation to make sure the patient gets the care that they’re looking for," she said.
But Ms Tesoriero said she did not feel reassured about physicians' conscientious objection clause "for a number of reasons", including a Canadian palliative care expert who "talked about the significant problems with compliance in Canada" in a recent visit to New Zealand.
She also referenced a UN disability rights report voicing extreme concern "about the claims she heard from disabled people on the ground in Canada about those in institutions who were asked to consider euthanasia or assisted dying.
"When we talk about choice, proponents of this Bill talk about it as though everybody exercises their choice from an even playing field, and that is just not the case," she said.
She added that there are "many disabled people who have talked to me on a daily basis about the fact they don't have the choice about things like where they live, who they live with, what kind of housing they can access".
"The overwhelming concern is that people feel that this type of regime will not provide a choice, but in fact provide a solution, and the solution being inadequate support services to disabled people and inadequate choices. I would far rather, as a country, that we're talking about providing adequate services for disabled people and enabling them to live a good life, than we were debating how to die a good death."
Dr Green countered that while there are "detractors on both sides" of the debate, the physicians "want every single citizen to have the same rights".
"The real issue in everything, not just in end of life care, is that there has to be a balance between what the Government will regulate … and the autonomy of the patient themselves to choose; to do elective surgery, to do controversial things like terminate babies," she said.
"We need to have a balance between how much the Government interferes and how much the people have the right to make their own choices, whether they are able-bodied or disabled; whether they are rich or they are poor – everybody needs to have the same rights."