A look at Canada's experience with legal euthanasia as MPs face second vote on End of Life Choice Bill

Tonight, New Zealand MPs will vote on whether to legalise euthanasia as the End of Life Choice Bill is read for a second time in Parliament.

Before the vote, Dr Stefanie Green, a leading Canadian expert in medically-assisted dying, answered questions from MPs Chris Bishop, Greg O'Connor and Matt King, in an event organised by ACT's David Seymour.

It comes as MPs are set to vote on the second reading of the End of Life Choice Bill , after the first reading passed 76-44. It has seen MPs intending to change their position from the last vote, such as Labour's Kiri Allan, who tweeted she was "not satisfied in the protections in the Bill to support vulnerable people" and will now vote against.

National's Judith Collins is intending to vote in favour, after voting against in the first vote, tweeting she was "concerned that the Select Committee process did not work as usual to address the flaws in the Bill, I hope to give David Seymour a chance to make the changes needed".

National's Maggie Barry, who has been consistently opposed to the Bill, said that in the event of it passing tonight she intends to submit over 100 proposed changes.

"There’s a lot of people who made submissions who are really unhappy if this bill goes past the second reading. We could easily top 120 (proposed changes)," she said yesterday. 

When asked if she was obstructing the process, she said it was "not filibustering… there’ll be substantial issues around the medicalisation".

Ms Barry went on to say: "There’s a large group of doctors that don’t want to be involved, a large group of nurses, palliative physicians, they don’t want a bar of it. The actual injection of a lethal dose that will kill people doesn’t need to be medicalised, for example. And removing the cloak of medical legitimacy could be a very good thing to do."

Health Minister David Clark would also be voting against. He said his personal view had been shaped through his experience with his grandmother. 

"My grandmother attempted to take her own life many times and she gave as a reason she felt she was a burden on society. I believe it’s very hard to put in place sufficient protection mechanisms to avoid that happening for people in society.

"I would say, I know the vast majority of doctors are incredible uncomfortable with the idea they would take the lives of their patients."

Disability Rights Commissioner Paula Tesoriero has also expressed concern that patients may feel coerced by their families to choose medically-assisted death.

"I'm concerned that the safeguards are woefully inadequate," she told TVNZ1's Breakfast. "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."

The Canadian experience - Dr Stefanie Green 

National MPs Chris Bishop and Matt King, Labour MP Greg O'Connor, along with ACT leader David Seymour questioned Dr Green on legal euthanasia in Canada.

How long has Canada had legal euthanasia?

It's been three years this month. I've had over 350 consultations for assisted dying and I've helped just over 150 people end their life.

How do you explain the euthanasia process?

A patient needs to make a written request for this, it can't just be verbal. The written request needs to be witnessed by two independent people, then there's a 10 day reflective period that needs to happen for them to decide if they're secure in their decision. Two separate clinicians need to see if the patient is actually eligible for the care and it needs to be done independently. If they both agree, then we can tell the patient they are eligible.

From personal experience, when I have the opportunity to tell someone they've become eligible, it is objectively therapeutic care. The patient really relaxes at that moment, it's a very emotional moment, and people will stop thinking about dying and start thinking about living for the rest of their life.

Once that happens, they may choose to go ahead, they may not to go ahead.  If they do, they set a date and a time, then we literally choreograph their death and plan it the way they wish, where they wish, how they wish, with who they wish, whatever play list they like if they want music.

Sometimes it's very simple, people are very, very ill and it's just two or three people around their bed at home, and other times I've seen parties of 50 people drinking champagne. A lot of emotion, a lot of closure. They're generally quite beautiful and moving.

What are the key takeaways from Canada?

We know right now about 1.5 per cent of all annual deaths in Canada are by an assisted death, we know that's where we expected to be. It's more than Oregon, it's less than Belgium, it's about a third of what's happening in the Netherlands.

The law was carved out by the Supreme Court. It was very clear, the Government then legislated a more restrictive eligibility criteria. Our law has held for three years, there's no jurisdiction in our country where it's been changed or challenged in any way. There are some court challenges to see if it might go back to Carter (the Supreme Court decision) , but it's staying very stable. 

There's been no court cases against any clinician, for any misuse or any abuse. We have oversight and monitoring in every province and every territory. 

People who are accessing assisted dying have access to specialised palliative care. In Ontario, 78 per cent of people who received an assisted death had access to specialised palliative care. 

Coercion is probably the number one argument that worries people.

This is not something I take lightly. I speak to patients, I speak to them privately, I speak to them repeatedly, I ask them how they heard about this, ask them why they want this and what their values are, I do this until I'm convinced there is no coercion. 

What about doctors who do not want to participate?

They simply opt out. Just like abortion care, they don't have to do it. It had nothing to do whether this law should exist or not.