Professor Roderick MacLeod:

I will respond to the question about coercion. Doctors are not trained to detect coercion. In the New Zealand legislation, all the assessing doctor has to do is to ask if the person made the decision of their own free will. Therefore, there is nothing to suggest that there is any way of detecting coercion. Similarly, I wanted to say earlier that of the approximately 300 people who sought assisted dying in the first year of our legislation, only three people were referred to a psychiatrist. Presumably the others were assumed to have competence. Yet, internationally recognised data suggests that at least 25% of people who are approaching the end of their life have a depressive illness. Therefore, either these depressive illnesses were not recognised or they were recognised and were ignored and it was all seen as part of the request for assisted dying.

In response to the Deputy’s question about requests for assisted deaths, as I said at the start, I have been practising palliative medicine since 1989. I am not a clinician anymore, but at least every month and sometimes every week, a person would say to me that they did not want to live like this, they had enough and they wanted out. That was before the palliative care team was involved. I can put my hand on my heart and say that only one person in those 30-odd years persisted in his desire for a hastened death, even though it was not legal at that time in New Zealand. Yet, even he said “Well, it will not be today, but it might be tomorrow”.

I know Professor White is very hot on the evidence, but when Professor David Sackett wrote about evidence-based practice, there were two elements to it. One was the data and the other was practical wisdom. We must acknowledge that there is practical wisdom that goes with decades of clinical practice and it may be at odds with what the evidence is saying. I do not know if I have answered the Deputy’s questions.