A Dutch euthanasia expert and critic has warned he's seen assisted dying in his country go from being seen as a last resort to a "project" to be managed.
But the man behind legislation passing through Parliament in New Zealand says the effect legalisation has had in the Netherlands is being exaggerated.
Act leader David Seymour's End of Life Choice bill – which would allow terminally ill adults request assisted dying - is returning to the House on Wednesday for the latest in a lengthy series of debates about last-minute changes.
Dutch healthcare ethics professor Theo Boer is among the most prominent critics of euthanasia laws in the Netherlands and was a member on a regional board that reviewed every act of euthanasia from 2005 and 2014, examining 4000 individual cases.
Boer – who previously supported euthanasia and has been brought to New Zealand by anti-euthanasia lobbyists – says since the Netherlands legalised assisted dying in 2002 there's been a consistent increase in uptake and a shift from seeing euthanasia as a last resort to a "good death".
That's despite the quality of palliative care also becoming better.
"The availability of euthanasia has very much changed the way we think about dying. Dying is more and more kind of a project. It is something that people are managing," he said.
"The initial reasons for euthanasia in the Netherlands was pain … People were beyond hope because there was no pain relief. But what I have seen is that the primary reason is not pain."
According to Boer's research, terminal cancer was the reason behind 95 per cent of cases of euthanasia in 2002, but only 68 per cent by 2016.
"Those people don't die because there's no adequate palliative care, they die because they think it is not a dignified way to die if they have to be taken care of by others."
So is it bad people consider death a "project"?
"Through making euthanasia possible society sends a signal that it is respecting liberal people that have choices. But it sends a second signal and, in my view, that signal is a signal of despair. It's a form of organised despair," he said.
But Seymour says while the uptake in the Netherlands has gone up, data from 2018 shows it could be levelling out and only still makes up about 4 or 5 per cent of total deaths.
"A hundred people die in the Netherlands and 96 of them don't use assisted dying. The other four do. So by what statistical standard is that normalisation?" he said.
"Doctors say 'no' to half of the people who ask already, so the idea that it has become a routine thing with no protections is not true."
He said the Dutch legislation was also significantly looser in its standards for allowing assisted dying.
"Ours is a lot more objective in the sense that two doctors have to judge that you are likely to die within six months," Seymour said.
END OF LIFE CHOICE BILL RETURNS TO PARLIAMENT
Seymour has promised a series of changes to his bill to secure votes ahead of its third-and-final reading. It passed the second vote, in June, 70 votes to 50.
On Wednesday, Parliament is expected to begin the third of five rounds of debate into amendments - this time considering the section of the bill that covers accountability, including how assisted deaths would be reviewed.
Major changes to other parts so far have included:
• Limiting the bill to only apply to those with six months to live, whereas it previously covered people with "grievous and irremediable" conditions
• Prohibiting a health practitioner from initiating any discussion about assisted dying
• Giving employment protections for any doctor, nurse, or psychiatrist who objects to taking part in the process on any ground
• Explicitly stating that if any pressure is suspected on a person applying for assisted dying, doctors and nurses must stop the process
While opponents of the bill have also been trying to get dozens of their own amendments added into the legislation, only Seymour has so far managed to get any changes through the House.