Ngaro AlfredHon ALFRED NGARO (National): Thank you Madam Chair. I take a call on Part 4 Related matters" and in particular clauses 24 and pertaining to this current Supplementary Order Paper (SOP) 259. I have taken into consideration what you have stated at the beginning of this sitting and what I'd like to do is to then—and I've amended that and I want to table an SOP in a moment but in particular on clauses 24 and 24A in regards to "Advance directive etc. may not provide for assisted dying" and in particular clause 24A(2). It's a concern because as it states as it is currently written "A person who after signing and dating the request form wishes to rescind a request to exercise the option of receiving assisted dying under this Act must communicate that wish to the attending medical practitioner or the attending nurse practitioner orally in writing" in which it's stated clearly here will be a rescind document. The SOP that I am wanting to introduce is in regards to the challenges around culture and communication. Many of those who are in vulnerable situations are often not given and afforded the ability to be able to understand the clarity around the decisions that they are making both from a health and from a medical practitioner's point of view and the views that are there. It's quite clear that we have many cultural competencies; we have culture considerations that are put in place in many forms of legislation to take this into consideration. Why is this important? We have over 220 ethnic groups that are recognised in New Zealand at the moment. We have 190 different languages that are there. Many times over most Government departments ensure that there is cultural competency. Why? Because we know the challenges that are before patients before medical practitioners. It doesn't get any more serious than this where a person has to make a decision around life and death and according to this clause it only has to be indicated orally. So the question that has to go to the member of the bill who talks about the importance of choice: what about the importance of ensuring that people know what choices that they are making? Many times when we think about it in different cases with different cultures people may be asked the question and if I talk about the Pasifika community people will nod and say yes. "Do you understand?" "Yes." The truth and the reality is they do not understand the technical implications in this regard. So I think it's critically important that this has to have some amendment to it if we are to include this bill into the House. I'd like to include in my SOP cultural considerations. There have been numerous departments who have actually had those culture considerations. It's about oral considerations it's about written and it's about interpretation of certain words. I state on the record that I was the chairperson for the Auckland District Health Board Pacific Health Advisory Committee. Even under that there were many situations in which we had families that were going into hospital having care and consideration even in regards to palliative care and yet they needed to have an interpreter there at every point and at every decision to ensure that they were fully aware and fully conscious of the decisions that would be made on their behalf. Also in that regard while we may be looking at a system that is monolithic in the sense that there is one way—I know the sponsor of this bill just thinks that we're some big melting pot we're all just chocolate covered we're all going to be one and that we're homogenous—the reality is there is huge diversity in this nation and in this country. I would like to put it to this committee that the members on the other side would consider this very clause—would consider this very clause. It's critically important that we look at that and look at it in regards to the specialist services that are regarded into this case. I think in this regards when I'm talking to Part 4 and clause 24A in particular and clause 24A(2)—a person who after signing would decide to rescind a decision—that's critically important. I also too want to speak too in regards to the SOP 373 from Kanwaljit Singh Bakshi which would amend clause 24B inside SOP 259. This is in regards to the welfare guardians and what it seeks to include from SOP 373 is that it would include "and attorneys". The purpose and the reason for that from Mr Kanwaljit Singh Bakshi is to ensure—the fact is that it is not only the welfare guardians but there potentially could be that in which not having a power of attorney could and should include what you call attorneys in this case and I think that's critically important. [Bell rung]CHAIRPERSON (Hon Anne Tolley): I call the Hon Alfred Ngaro. Hon ALFRED NGARO: Thank you Madam Chair. Thank you for allowing me to complete on behalf of my colleague who can't be here SOP 373. Again what it states—and it states in here—in regards to after clause 24B on SOP 259 "Welfare guardians" is that it would insert "and attorneys" in this case. That's critically important. As it reads as the full part of the bill welfare guardians—and then including "and attorneys"—have no power to make decisions to take action under this Act. This is a vulnerable time. We need to ensure that the right safeguards are put in place. As it further reads in the bill "A welfare guardian"—"and attorney"—"appointed under the Protection of Personal and Property Rights Act 1998 for a person does not in that capacity have the power to make any decision or take any action under this Act for that person." We are in a situation where elder abuse is at a state in which there's real concern and it often has been shown whether it be through Age Concern and other organisations NGOs that are involved in the situation—they've clearly indicated that 75 percent of that type of elder abuse is by either family members or people that are trusted and known around them. These safeguards in this regard—in regards to SOP 373—are critically important so that we ensure that the right people are put in place in that regard. I want to then conclude my part by talking about SOP 379 in the name of Agnes Loheni which talks to clause 27: "without lawful excuse". This Supplementary Order Paper amends Supplementary Order Paper 259 amending the End of Life Choice Bill by clarifying that legislators do not contemplate that there could be any lawful excuse for (a) completing an approved form for another person without their consent or (b) altering or destroying an approved form for another person without their consent. We think and I believe that these clauses are critically important. Part of our role as legislators is to make this bill the best possible. Even though we don't support the bill—it is unsafe—we do want to try and ensure that actually there are some clauses in there that ensure that in regards to the vulnerable situation around the consenting unless there are powers of attorney—this is a critically important part. I want to state that this SOP 379 again goes to the heart of the issue to make this bill safe. I want to end my final comments in the time that I have available and I want to refer back again to clause 24. Again it's about the other rights and duties not affected and my SOP that I will submit and table for the committee talks about some of those cultural considerations that are there and in part of that "A provider of assisted dying services must ensure that the services of a competent interpreter are provided for a person who requests assisted dying services". It is often those that are more vulnerable—we know that we've already seen that in New Zealand alone the inequities in regards to Māori in the healthcare services are already out there. We know that it's there. Many members on the other side realise that this is the reality. What we are stating here is that we have the appropriate interpreters number one who understand the medical conditions the ramifications but also who understand the values and views of those different cultures that are there. We know that even under the Coroners Act that has been passed in this House that consideration is put into law and it does state things such as the values beliefs and customs but also the spiritual considerations of those family members and those people in that regards. I think it's critically important that cultural consideration be recognised. That ensures the fact is that people are fully aware—they're competent of the situation. In many cases we've heard from doctors who've said sometimes there is a misdiagnosis. If there has already been—as stated in this part of the bill—an advance directive and there needs to be a change if the appropriate interpreter has not been put in place to rescind the decision then that puts that person in a vulnerable situation. We've already seen that happen in other jurisdictions internationally. There's been a case that's gone to the high court in the Netherlands and in that case again an advance directive was there. However at that point in time the patient themselves wanted to rescind and they tried to do that orally. It was a tragic situation where the family members had to hold that person down—that patient down—so that they could be administered a lethal dose. That's the reasons why on this side we would urge that there would be some consideration to these SOPs and that there would be consideration around cultural considerations to make it appropriate and right so people fully understand the decisions that are being made on their behalf and the decisions that they're making in regards to assisted dying."