A strong majority of New Zealand voters approved the legalization of assisted suicide and euthanasia for the terminally ill Oct. 30. Foes of legalization said many voters appeared confused about the measure’s far-reaching effects and warned that the move will have consequences for the vulnerable.

The nationwide referendum passed with support from 65% of voters on Friday. It allows terminally ill persons who are believed to have six months or fewer to live to be euthanized or to take a lethal dose of prescribed drugs themselves, on the condition that two doctors agree the person is well-informed. Patients are eligible if they show significant, ongoing decline in physical ability and experience “unbearable suffering that cannot be eased.” The law will take effect Nov. 6, 2021.

Legalization opponent Euthanasia-Free NZ said some 80% of adult New Zealanders appeared to misunderstand the referendum. Only 20% knew the act would not make it legal to turn off life support machines. Such a practice is not illegal under current law.

“It seems that most New Zealanders voted for an end-of-life choice that is in fact already legal,” Renée Joubert, executive officer of Euthanasia-Free NZ, said Oct. 30.

Surveys indicated similar confusion about eligibility criteria. Only 29% knew that terminally ill people who have depression or another mental illness would be allowed to seek euthanasia. Only 13% of adults knew that the act does not require an independent witness.

The New Zealand law does not require a waiting period before a lethal dose is prescribed, nor does it require a competency test.

In November 2019 the New Zealand Parliament approved the bill, officially called “The End of Life Choice Bill,” by a vote of 69-51. The bill had the backing of Prime Minister Jacinda Ardern of the ruling New Zealand Labour Party and her main rival, Judith Collins of the center-right National Party, the New York Times reports. Voters had to approve the act in referendum in order for it to become law.

An earlier version of the bill would have allowed those with severe or incurable conditions who were not terminally ill to seek euthanasia or assisted suicide as well.

Joubert objected that parliament voted down more than 100 amendments that “could have made this law safer” and said the law lacks safeguards that have been standard in U.S. law.

“It’s disappointing that the New Zealand public were generally uninformed about the details of the End of Life Choice Act,” she said.

When New Zealand's National Party was governing the country, a parliamentary study on assisted suicide and euthanasia proposals concluded that “the public would be endangered” by legalization of the practices.

In 2017, the National Party-controlled Parliament's health committee said submissions on the proposal “cited concern for vulnerable people, such as the elderly and the disabled, those with mental illnesses, and those susceptible to coercion.”

“Others argued that life has an innate value and that introducing assisted dying and euthanasia would explicitly undermine that idea. To do so would suggest that some lives are worth more than others. There were also concerns that, once introduced, eligibility for assisted dying would rapidly expand well beyond what was first intended,” the committee said.

In 2018 the Catholic bishops of New Zealand published resources against assisted suicide legislation and encouraged Catholics to oppose legalization. The Nathaniel Centre, the New Zealand bishops-founded Catholic bioethics center, posted resources on Church teaching on euthanasia and assisted suicide to their website and social media pages ahead of the referendum.

Ahead of the election, the Nathaniel Centre said the act is “badly drafted and seriously flawed.”

“It will expose many New Zealanders to the risk of a premature death at a time when they are most vulnerable. Whatever one’s views about the idea of euthanasia, it is not compassion to vote for a dangerous law,” the center said. “The group most at risk if we legalize euthanasia and assisted suicide are those vulnerable to the suggestion they would be ‘better off dead’ – our elders, disabled people, and people with depression and mental illness who find themselves fitting the eligibility criteria.”

The center cited the Lawyers for Vulnerable New Zealanders, a group of over 200 lawyers, including some supporters of euthanasia, opposed the act on the grounds it is too broadly drafted, “dangerous,” and “broader in its scope and riskier than comparable laws overseas.”

Other opponents of the act included the New Zealand Medical Association, Hospice New Zealand, Palliative Care Nurses and Palliative Medicine Doctors.

David Seymour, the lawmaker who sponsored the act, praised its passage as “a great day,” the New York Times reports. In his view, the vote made New Zealand “a kinder, more compassionate, more humane society.”

Pope Francis has on multiple occasions spoken out against assisted suicide and euthanasia, both of which are “morally unacceptable” according to Church teaching. In 2016, Pope Francis told medical professionals that assisted suicide and euthanasia are part of the “throwaway culture” that offers people “false compassion” and treats human persons like a problem.

Euthanasia is legal in the Netherlands, Belgium, Luxembourg, Canada and Colombia. Doctor-assisted suicide is legal in Switzerland. Some U.S. states have legalized assisted suicide.

Also on New Zealand's ballot was a proposal to legalize recreational marijuana use, allow adults age 20 and over to buy cannabis from licensed outlets, and allow adults to grow the plant at home. Advertising and smoking the drug in public would be banned. That proposal failed by a vote of 53% to 46%, according to preliminary results.

The country already has legalized medical marijuana.

Critics of the recreational use legalization warned that it would make the drug more accessible to children, Bloomberg News reports. They said cannabis is a serious drug harmful to mental health, especially among adolescents.

For their part, advocates said legalization would weaken the power of drug trafficking gangs, regulate quality and raise awareness of health risk through the use of warning labels. They said indigenous Maori people are disproportionately arrested and convicted for the drug.

Some figures suggest that New Zealanders are among the biggest users of marijuana in the world, with 80% having tried the drug by age 20 and 12% reporting use of the drug in the past year.

Pope Francis criticized drug use and legalization in a 2014 address to the International Drug Enforcement Conference in Rome.

“Let me state this in the clearest terms possible: the problem of drug use is not solved with drugs! Drug addiction is an evil, and with evil there can be no yielding or compromise,” the pope said. “To think that harm can be reduced by permitting drug addicts to use narcotics in no way resolves the problem. Attempts, however limited, to legalize so-called ‘recreational drugs’, are not only highly questionable from a legislative standpoint, but they fail to produce the desired effects.”