24 May 2018

A citizens' jury on euthanasia

From Our Changing World, 9:06 pm on 24 May 2018

A citizens’ jury on whether or not to legalise euthanasia and assisted dying in New Zealand resulted in two thirds of jurors supporting and one third opposing a law change.

The University of Otago organisers say this shows that “an informed public will always be deeply divided on the issue, because of a difference in weighing up the arguments for compassion and individual choice versus potential community harm.”

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Photo: Soins pallatifs

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Earlier this year 15 people in South Dunedin took part in a citizens’ jury at the University of Otago. They were asked to consider whether they thought there should be a law change to allow euthanasia and assisted dying.

While the majority were mostly supportive or unsure to begin with, people say the process helped clarify their opinions, with some even changing their minds during the two days of informed deliberation.

At the end, the jury was split with 10 solidly in favour of a law change and five totally opposed.

The organisers says this showed that the issue is genuinely very difficult, and that those on both sides of the issue have good moral reasons for their decisions, which need to be taken into account by politicians considering the End of Life Choice Bill.

What is a citizens’ jury?

Citizens’ juries are an exercise in participatory democracy. A group of randomly selected jurors consider and discuss sometimes conflicting evidence and opinion from experts, and try to reach agreement on tricky moral problems.

“Citizens’ juries are based on the idea that there is intractable disagreement generally in public policy, and about citizens being agents in making public policy,” says Emeritus Professor Charlotte Paul. Charlotte is a retired epidemiologist from the University of Otago. She was one of the organisers of this citizens’ jury, and chair of the expert steering group that provided advice and oversight.

Dr Richard Egan works in health promotion at the University of Otago. It was his interest in end-of-life issues that kick-started the idea of a citizens’ jury on euthanasia and assisted dying.

 “People on both sides of this issue think that ‘if people really understood this they would agree with me’,” says Richard. “And that was what was behind this deliberation process: if you had all the information about euthanasia and assisted dying, what would you decide and why.”

Dr Simon Walker, is a bioethicist at the University of Otago who is interested in end of life care. He was intrigued by the idea of a citizens’ jury and what he thought it might offer to public debate on a very contentious topic.

“It’s curious to find out whether views will change after informed deliberation. There is this idea that we just tend to filter arguments in accordance with our existing prejudices – [but] interestingly, I don’t think that’s what happened with our process,” says Simon.

Legislation to legalise medically assisted dying

A number of countries and states such as Canada, Victoria in Australia and Oregon in the United States already have legislation that allows medical assistance in dying.

In New Zealand, Lecretia Seales' well-publicised application to the High Court in 2015 for a ‘right to die’ was followed by a Health Select Committee enquiry into euthanasia and assisted dying which received nearly 22,000 submissions.

The committee’s report, published last year, made no recommendations but said that the topic was ‘very complicated, very divisive, and extremely contentious’.

By the time that report came out, David Seymour’s End of Life Choice Bill had already been drawn from the parliamentary ballot. It passed its first reading in parliament in December 2017 and is currently before the Justice Select Committee.

This bill 'gives people with a terminal illness or a grievous and irremediable medical condition the option of requesting assisted dying.'

The select committee has received a record number of submissions – more than 35,000 - and will spend the next six months travelling around New Zealand to hear more than 3000 oral submissions.

The report from the University of Otago citizens’ jury is being put forward to the committee for consideration.

Other citizens’ juries

Citizens’ juries, or citizens’ deliberations as they are sometimes called, had their genesis in the United States in the early 1970s. They have been used in a number of countries to advance often controversial or divisive areas of public policy.

Citizens’ juries have considered everything from the regulation of hog feed lots to the future of electricity in the United States, obesity in Australia and abortions in early pregnancy in Ireland.

Charlotte has been involved in two other citizens’ juries at the University of Otago.

The first jury took place 10 years ago when the debate was whether breast screening should start at age 40 or 50.

The second jury, in 2010, considered access by public health researchers to personal medical records. This was essentially a discussion about personal privacy versus public good.

In both cases, members of the juries significantly changed their minds. All but one of the breast cancer jury moved from wanting breast screening for 40-49 year olds, to agreeing that the screening age should not be lowered to 40.

The second jury was initially uncomfortable about researchers having access to their medical records, but ended up unanimously agreeing that researchers should have access to study the safety of medicines in the interest of public good.

More information on attitudes to euthanasia in New Zealand

The euthanasia debate: synthesising the evidence on New Zealander's attitudes, is a review of 20 years of research in New Zealand (published in October 2018).