Pro and anti-euthanasia campaigners have clashed over whether a teenager in New Zealand should be able to choose to end their life without telling their parents.
A debate on the End of Life Choice referendum tonight looked at how New Zealand's proposed law change compared to overseas countries, how it could work in practice, and whether it could be improved.
It was hosted by Newstalk ZB's Heather du Plessis-Allan and featured Wellington GP Mary English and Hospice NZ clinical director Rod Macleod in the anti-euthanasia camp and terminal cancer patient Stuart Armstrong and Dr John Bonning, an emergency medicine specialist from Waikato Hospital, in the pro-euthanasia camp.
The most heated discussion centred on whether the End of Life Choice Act had adequate safeguards. The bill would allow a terminally ill patient aged 18 years and older to request assisted dying.
English described it as "very weak", noting the absence of a requirement for a patient to consult their family or friends about their decision to request an assisted death.
"That could be the mother or father of an 18 year-old who is terminally ill," she said.
"And the first those parents might get to know about this is if they get a phone call or a death certificate coming to them. And that's something that no parent wants."
Bonning said any patient, regardless of age, would also need to have a terminal illness and "intolerable suffering" to be eligible for an assisted death.
"They're allowed to vote, they're allowed to go to war, they're allowed to make their own choices."
Foreign jurisdictions with similar euthanasia laws had shown that young people were highly unlikely to apply for assisted dying, he said. Since Victoria, Australia, had legalised assisted dying last year, the age range of people who had died was between 32 and 100.
Macleod, who had worked in palliative care for more than 30 years, said requiring a doctor to consult with a patient's family would help them detect whether the person was being coerced into dying.
Under the proposed law, a doctor must halt a patient's application if they detect any signs of coercion.
Asked how the End of Life Choice Act could be improved, English and Macleod said it should include a minimum period between a patient's request for assisted dying and taking the lethal dose.
"There is no cooling off period," Macleod said. "There are no witnesses to this act."
Macleod highlighted officials' advice that a person could be dead four days after they first requested euthanasia.
However, the ministry has also said this assumed all parties were available, there were no objections, and no concerns about competency. As a result, the process was more likely to take months.
The panel disagreed strongly on whether New Zealand's bill was more restrictive than other countries' laws.
English said Victoria's law had a cooling off period, a requirement for two sworn witness statements, and specialists were involved in patient's applications rather than GPs. A psychiatrist was only required in New Zealand if there were any doubts about a patient's competency.
Bonning said there were 45 safeguards in New Zealand's law, and it was considered one of the most restrictive in the world. It was based on well-established, proven models of euthanasia laws overseas.
"There are 150 million people in countries around the world that have used it successfully. There is no slippery slope, there is no coercion or very, very little of it, and no countries have rescinded this legislation."
Armstrong, who has had prostate cancer for six years, said he wanted a death which reflected the way he lived his life.
"That's full of energy and enthusiasm and love for life. I'll be blowed if I'm stuck in some hospital bed while that happens."
In the most heated part of the debate, he told English: "I don't to face a gnarly end, and have to face it because people like you want to stick your noses in my own choices, thank you."
Five things to know about the euthanasia referendum
New Zealand will vote next month on whether it wants voluntary euthanasia to be legalised.
Before you cast your vote, here are five things you should know.
1. You have the final say.
The referendum is binding, and a majority "yes" vote will mean voluntary euthanasia will be made legal exactly a year after election day (October 17). A "no" vote will mean we keep the status quo.
2. We've been here before - sort of.
Parliament has twice voted against laws to legalise euthanasia in New Zealand. Former National MP Michael Laws' Death with Dignity Bill was heavily defeated in 1995. And NZ First MP Peter Brown's bill by the same name was narrowly defeated - by just two votes - in 2003.
On the latest attempt, Act Party MP David Seymour's End of Life Choice Act has already been passed by Parliament - but relies on a public vote to get it over the line.
3. If legalised, euthanasia would not be available to anyone.
It would be limited to NZ citizens or permanent residents who are 18 years or older and suffer from a terminal illness which is likely to end their lives within six months.
They also need to be:
• in an advanced state of irreversible decline in physical capability
• experiencing unbearable suffering that cannot be relieved in a manner that they consider tolerable
• competent to make an informed decision about dying
They also cannot be eligible on the basis of age, mental illness, or disability alone.
4. Opponents are concerned, however, that legalisation might create risks for a broader group.
Some countries have broadened their euthanasia laws. This is being considered in Canada, which New Zealand's law was partly based on. A law change there could soon make euthanasia available to non-terminal patients.
Supporters of the End of Life Choice Act say that doesn't foreshadow what could happen here. Those changes were a response to a ruling by Canada's Supreme Court, and were based on a constitution which does not exist in New Zealand. Any further changes to New Zealand's law would need to get through Parliament.
5. Euthanasia generally benefits the most privileged people in society.
Analysis of deaths in the United States, Canada and Europe found those most likely to access assisted dying were old, white, well-educated and relatively wealthy.
This is mainly because this group is more likely to be able to have better access to the healthcare system, and better able to navigate the medical and bureaucratic hurdles to assisted dying.