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Death with Dignity Act, 1757

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Death with Dignity Act, 1757

13th Cortes Federales
Long title An Act to permit, under safeguards, the provision of assistance to die to adults suffering intolerably from a terminal or grievous and irremediable condition; to give effect to advance directives; to establish the Federal Commission on Assisted Dying; among other purposes.
Bill Number FA-1757-047
Introduced by Margaux Vasseur (independent, Alduria)
Extent Entire Federation of Nouvelle Alexandrie
Dates
Bill Status Proposed
Other legislation
Related legislation

The Death with Dignity Act, 1757 (Alexandrian: Loi sur la mort dans la dignité, 1757; Martino: Ley de Muerte Digna, 1757; Wechua: Allin Wañuymanta Kamachiy, 1757) is proposed legislation of Nouvelle Alexandrie that would permit, under safeguards, the provision of assistance to die to an adult who suffers intolerably from a terminal or grievous and irremediable condition. The bill would allow a person to take the means of death themselves, and would allow a physician to administer it to a person unable to act for themselves. It would give legal effect to advance directives and would establish a Federal Commission on Assisted Dying to authorize and review cases.

The bill is a private member's measure brought by Margaux Vasseur, an independent crossbench deputy from Alduria, on 19.VIII.1757 AN. The parties have not imposed a position on it, and it is to be decided on a conscience vote. Vasseur, a former community nurse, entered the Federal Assembly at the 1754 election as one of the independents returned in Alduria after the collapse of the Caisse Régionale de l'Alduria, and she has described the bill as drawn from the death of her mother.

The bill is before the 13th Cortes Federales and awaits a second-reading debate. The breadth of its eligibility, and in particular its provisions on psychological suffering and on advance directives, has drawn opposition from the Nazarene Church, from disability advocates, and from some deputies who say they would support a narrower measure.

Background

Assistance to die was not lawful in the Federation before the bill. End-of-life care fell within the existing health system, where the Seguro de Salud Federal funds hospice services and the public and private hospitals provide palliative treatment. The Healthy Families Plan and the wider pro-natalist tilt of New Alexandrian health policy had shaped a system built to extend life, not to end it.

The bill's sponsor came to the question through both halves of her public life. Margaux Vasseur had worked as a community nurse in Alduria before standing for the Federal Assembly. She was returned at the 1754 election as an independent, part of the wave that followed the failure of the Caisse Régionale de l'Alduria, the cooperative savings bank whose troubles in 1753 AN cost the Democratic Socialist Party all but fifteen of its sixty-two Aldurian seats. Vasseur built her standing on the depositors the collapse had exposed, the miners, teachers, and care workers who had trusted a regulated institution and been left to wait in queues. She has said the same conviction runs through the bill: that institutions take agency from ordinary people at the moments they are weakest, and that a death is one such moment. She has spoken of nursing her mother through a long terminal illness in which, she says, her mother was given no say over her own end.

The bill set the two strongest provisions of the Proclamation of Punta Santiago against each other. Article 8 of the Proclamation provides that the human dignity of every citizen shall be secured and that enforcing it shall be a task of the State. Vasseur and her supporters read that article as a guarantee of dignity in death and of freedom from suffering prolonged against a person's will. The Nazarene Church and other opponents read the same article as a duty of the State to protect life, which they say cannot extend to sanctioning its ending. Supporters also invoked the Right to Personal Liberty under Article 10 and the Right to Privacy under Article 24. Opponents invoked the Equality Principle of Article 9, which bars discrimination on the ground of corporal or mental disability, and argued that a state offering death to those who suffer tells disabled citizens their lives are valued less.

The religious objection was not confined to one faith. The Nazarene Church, the established church recognized under the Proclamation, opposed the bill on the ground that life is not a person's to surrender. Among Wechua communities, where the Faith of Inti remains the practice of most and blends in places with Nazarene and Melusinian forms, the objection drew on ancestral understandings of death and the passage of the dead. The result divided opinion along lines that did not match the usual division between religious and secular, or between the government and the opposition.

The bill arrived in a year already heavy with death. The 1757 Cajamarca micrasquake and the Islas de la Libertad hurricane had each taken lives, and the economy was under strain from the Alexandrium market collapse. Opponents said a measure to end lives had no place in such a year. Vasseur said it was the year that proved her case, that a state which could not spare its people suffering owed them at least the choice to end it.

Key provisions

The bill would permit assistance to die for an adult who is ordinarily resident in the Federation, has the capacity to decide, and makes a voluntary and settled request. It would not apply to a person under the age of majority in any circumstances.

A person would be eligible on one of two grounds. The first is a terminal illness expected to cause death within a period set in the bill. The second, and the wider, is a grievous and irremediable medical condition that causes the person suffering they find intolerable and that cannot be relieved by means they are willing to accept. The bill states that suffering may be physical or psychological. Where a request rests on psychological suffering, the bill requires an assessment by a psychiatrist in addition to the other steps, and a longer period of reflection.

The bill would give legal effect to an advance directive. A person with capacity could record, in advance, a request for assistance to die on the occurrence of a future condition under which they would lose the capacity to decide, including conditions of progressive cognitive decline. The directive would take effect only on conditions named in it and confirmed by the Commission.

A request would pass through assessment by two independent physicians, a determination of the person's capacity, and a period of reflection between the request and the act. The bill would establish a Federal Commission on Assisted Dying to authorize cases, with prior authorization required for requests resting on psychological suffering and for requests under an advance directive. The Commission would keep records and report each year to the Cortes Federales.

A person able to act for themselves would take the prescribed means without assistance. A physician could administer the means to a person who, by reason of their condition, cannot do so, or where a valid advance directive so provides. The bill would not compel any clinician to take part, and it would not compel any hospital or institution to provide the service. The conscientious-objection provision was understood to allow the Carrillo National Health System and the hospitals of the Nazarene Church to decline to participate.

The bill would make it an offense to coerce a person into a request, or to procure a request by fraud or pressure. It would bar a request from being acted on where cost of care, want of support, or a person's disability is a reason for it, and it would require the Commission to refuse such cases. The duties and offenses would commence after a transition period, with the Commission established first.

Legislative progress

Legislative progress of the Death with Dignity Act, 1757
Stage Date Chamber Action Votes (Y-N-A) Details
1 19.VIII.1757 AN Federal Assembly Introduction and first reading - Presented by Margaux Vasseur as a private member's bill
2 24.VIII.1757 AN Federal Assembly Listed for second reading - Set down for a conscience vote; no party position imposed
3 Second-reading debate pending

The decision to allow a conscience vote removed the discipline that ordinarily held the parties together and exposed divisions within each of them. The governing Federal Humanist Party, whose program joins a humanist tradition to a conservative one, divided along that seam. The government took no collective position. Vice-Premier Fred Strong said the matter was one for each member to weigh in conscience and that the Council of State would not whip it, a formula that acknowledged the party could not be held to a single line.

Opposition came from more than one direction, and the directions did not align. The Nazarene Church, through the Alexandrian Curia, stated that the bill set the State against its duty to protect life and asked deputies of faith to reject it. Disability advocates argued that the bill's reach beyond the terminally ill, into grievous conditions and psychological suffering, placed disabled and chronically ill citizens under a pressure the law should not create, and they grounded the argument in the Equality Principle of Article 9. Deputy Tuta Hualla of the Alliance for a Just Nouvelle Alexandrie, who represents the Wechua Nation, joined that concern to a further one, that the poor and the unsupported would feel a pull toward a door the comfortable would never need, and to the place of death in Intian practice.

A distinct line of opposition came from deputies who said they could support a narrow bill but not this one. They drew the line at the two widest provisions, psychological suffering and the advance directive, and argued that a measure built from one terminal case had been written far past it. Leader of the Opposition Marcos Ferreira Gonçalves said the Alliance would not whip the vote and that he was not persuaded the safeguards held for the conditions the bill named. The breadth that drew this objection was the same breadth that supporters of a fuller right defended, and the bill's prospects turned on a chamber that agreed on neither the principle nor its limits.

An independent-minded FHP delegate by the name of Esteban Garza, a confessed atheist from Alduria, proposed two amendments. The first was to rename the Commission to the Federal Commission on Dignified Decease, while the second was to include a provision prohibiting exercise of the Act to professed and practicing members of faiths that presently opposed the measure. These faiths were listed. One would have to execute a written form, duly witnessed, disclaiming membership of the faith, to enable their eligibility under the measure.

Fred Strong subsequently tabled an amendment that would limit eligibility to those burdened with a terminal condition or rendered irreparably incapable of effective labour. He additionally sought to add safeguards whereby no psychological condition would ever be considered a sufficient ground for access to assisted dying.

Bill text

Death with Dignity Act, 1757

THE READING OF
A
BILL
TO
permit, under safeguards, the provision of assistance to die to adults suffering intolerably from a terminal or grievous and irremediable condition; to give effect to advance directives; to establish the Federal Commission on Assisted Dying; among other purposes.

Death with Dignity Act, 1757

Presented by Margaux Vasseur
Ordered, by the Cortes Federales of Nouvelle Alexandrie,
to be Printed, 19.VIII.1757 AN.

BE IT ENACTED by the King's Most Excellent Majesty, by and with the advice and consent of the Cortes Federales, in this present session assembled, and by the authority of the same, as follows:-


PART I
GENERAL PROVISIONS

Article 1: Citation.

  1. This Act may be cited as the "Death with Dignity Act, 1757".

Article 2: Definitions.

  1. For the purposes of this Act:
    1. "assistance to die" means the provision to an eligible person of the means to end their life, whether taken by that person or administered to them under Article 12;
    2. "capacity" means the ability to understand, retain, and weigh the information relevant to a decision and to communicate that decision;
    3. "terminal illness" means an illness that is expected to cause death within the period prescribed by regulation;
    4. "grievous and irremediable condition" means a serious and incurable illness, disease, or disability that causes a person suffering that they find intolerable and that cannot be relieved by means they consider acceptable;
    5. "advance directive" means a request recorded under Article 7;
    6. "the Commission" means the Federal Commission on Assisted Dying established under Article 14.

Article 3: Purpose.

  1. The purposes of this Act are:
    1. to allow an adult who suffers intolerably from a terminal or grievous and irremediable condition to seek assistance to die;
    2. to provide safeguards against error, coercion, and abuse;
    3. to give effect, in the matter of dying, to the dignity, liberty, and privacy guaranteed by the Proclamation of Punta Santiago.

Article 4: Scope.

  1. This Act applies to a person who is an adult, has capacity, and is ordinarily resident in the Federation.
  2. Nothing in this Act permits assistance to die for a person under the age of majority, in any circumstances.
PART II
ELIGIBILITY

Article 5: Eligible persons.

  1. A person is eligible for assistance to die where they:
    1. have capacity and make a voluntary and settled request, free of coercion;
    2. are suffering from a terminal illness or a grievous and irremediable condition; and
    3. have been informed of their diagnosis, prognosis, and the care and treatment available to them, including palliative care.

Article 6: Psychological suffering.

  1. Suffering under this Act may be physical or psychological.
  2. Where a request rests, in whole or in part, on psychological suffering, the person shall in addition be assessed by a psychiatrist, and the period of reflection under Article 10 shall be extended as prescribed.

Article 7: Advance directives.

  1. A person with capacity may record an advance directive requesting assistance to die on the occurrence of a future condition under which they would lose the capacity to decide, including a condition of progressive cognitive decline.
  2. An advance directive takes effect only where the condition named in it has occurred and the Commission has confirmed that the directive applies.
PART III
PROCESS AND SAFEGUARDS

Article 8: Request.

  1. A request for assistance to die shall be made by the person, in writing or by a means the Commission accepts where writing is not possible, and may be withdrawn at any time.

Article 9: Independent medical assessment.

  1. A request shall be assessed by two physicians acting independently of each other, who shall confirm that the person is eligible under Article 5 and has capacity.

Article 10: Reflection.

  1. A period of reflection, as prescribed, shall pass between a request and the provision of assistance to die, during which the request may be withdrawn.

Article 11: Authorization by the Commission.

  1. No assistance to die shall be provided without the authorization of the Commission.
  2. The Commission shall give prior authorization, on the papers before it, where a request rests on psychological suffering under Article 6 or is made under an advance directive under Article 7.

Article 12: Manner of provision.

  1. A person able to do so shall take the prescribed means themselves.
  2. A physician may administer the prescribed means to a person who, by reason of their condition, is unable to take it themselves, or where a valid advance directive so provides.
PART IV
PROTECTIONS

Article 13: Conscientious objection.

  1. No person shall be required to take part in the provision of assistance to die.
  2. No hospital, clinic, or other institution shall be required to provide assistance to die.

Article 14: Protection against pressure.

  1. A request shall not be acted on, and the Commission shall refuse it, where cost of care, want of support, or a person's disability is a reason for the request.
PART V
THE FEDERAL COMMISSION ON ASSISTED DYING

Article 15: Establishment.

  1. There is established a Federal Commission on Assisted Dying.
  2. The Commission shall include physicians, a psychiatrist, a lawyer, and persons of standing in the field of ethics and of the care of the disabled and dying, appointed on terms set in regulation.

Article 16: Functions.

  1. The Commission shall authorize and review cases under this Act, keep a record of every case, and report each year to the Cortes Federales on the operation of the Act.
PART VI
OFFENSES

Article 17: Offenses.

  1. A person who coerces another into a request, or who procures a request by fraud or pressure, commits an offense.
  2. A person who provides assistance to die otherwise than in accordance with this Act commits an offense.
PART VII
CLOSING PROVISIONS

Article 18: Commencement and application.

  1. This Act shall apply to all of the Federation of Nouvelle Alexandrie.
  2. This Act shall not become law unless it has been given Royal Assent by H.M. King Sinchi Roca II.
  3. This Act shall be published in the Federal Gazette and made publicly available within seven (7) days of Royal Assent.
  4. The Commission shall be established within six (6) months of Royal Assent.
  5. The remaining provisions of this Act shall come into force on 1.I.1759 AN.
  6. In the event any provision or part of this Act is found to be invalid or unenforceable, only that particular provision or part so found, and not the entire Act, shall be inoperative.

Reaction

The bill drew reaction across the Federation out of proportion to its standing in the chamber. Few observers expected it to reach a second-reading debate, and fewer a vote, yet in the weeks after its introduction it became a focus of public argument. Religious and professional bodies issued statements they had not previously been pressed to make, demonstrations were held in several cities, and the bill's most contested provisions, those on psychological suffering and on advance directives, drew objection from quarters that did not otherwise agree.

Religious organizations

The Nazarene Church led the opposition. The Alexandrian Curia restated that life is not a person's to surrender, and the Archbishop of Geneva issued a pastoral letter, read in parishes across the Federation, calling on the faithful and on deputies of faith to reject the bill. Church teaching held that the duty under Article 8 of the Proclamation of Punta Santiago to secure human dignity was a duty to protect life, not to permit its ending. The Church confirmed that its hospitals would not provide assistance to die under any law.

The objection was not confined to the Nazarene Church. Leaders of the Faith of Inti, the practice of most Wechua, spoke against the bill on the basis of ancestral understandings of death, and statements followed from Melusinian, Ladino, and Zurvanite communities. Faiths that seldom made common cause had aligned against a single measure.

Medical profession

The medical profession divided. Palliative-care specialists and ethicists at the Dos Gardenias School of Medicine argued that the answer to a hard death was investment in hospice and pain relief, of which the Seguro de Salud Federal already funded a measure, rather than a means to end life. Other physicians supported a patient's right to choose. The professional bodies of the Federation's doctors declined to adopt a single position and reported their members were split.

The institutions took clearer stances. The Carrillo National Health System, the largest provider in Alduria and a foundation of the House of Carrillo, stated that it would not provide assistance to die. The Federal Hospital System referred questions to the Department of Social Security and National Solidarity. The royal household made no comment, in keeping with the practice that the Crown does not speak to legislation before the Cortes Federales.

Disability and civil liberties groups

Disability advocates were among the bill's most determined opponents, and they argued from the Equality Principle of Article 9, which bars discrimination on the ground of corporal or mental disability. They held that a law offering death to those who suffer from grievous and irremediable conditions placed disabled and chronically ill citizens under a pressure the State should not create, and they pointed to the reach into psychological suffering as evidence that the bill's limits were not secure. Campaigners for the bill answered from the Rights to Personal Liberty and Privacy under Articles 10 and 24, and held that the decision belonged to the person whose life it was. The New Alexandrian Civil Liberties Union did not take a single position, its members divided between those who read the bill as a matter of autonomy and those who doubted its safeguards.

Public opinion

Surveys found the public divided along the same line that divided the chamber. A survey commissioned by NBC Newsfeed found that a majority supported assistance to die for a person with a terminal illness, while support fell below half for the provisions on psychological suffering and on advance directives. Vigils and marches were held outside the Legislative Palace and the cathedrals, by supporters and opponents alike. The communities that had carried Margaux Vasseur into the Federal Assembly, the depositors and workers of Alduria and the Wechua Nation, were themselves divided, strong in the Nazarene and Intian faiths and uneasy at the cause their representative had taken up. Deputy Tuta Hualla had raised the same unease in the chamber, warning that the poorest would feel a pressure the comfortable never would.

Press coverage

The bill was known by competing names. Its supporters used the title Vasseur had given it, opponents called it the Euthanasia Bill, and much of the press settled on the Vasseur Bill. Editorial opinion divided, some titles backing a narrower measure and others rejecting any. Vasseur became a national figure in the argument and refused to amend the bill to remove the provisions on psychological suffering and advance directives, the provisions her critics most opposed. She said she would not cut it to make it easier to pass: "I wrote it from my mother's death and from deaths a smaller law leaves out. I will not make it smaller to make it pass."

Humanism

In the cadres of the FHP support for a measure approaching the implementation of euthanasia With a eugenic criteria was balanced with concerns that the voluntary aspect might lead to the unnecessary wastage of viable subjects who might otherwise be set through their labour to instantiating the Human Supremacy on Micras.

See also

References

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