Assisted dying remains a contentious issue in the health sector nearly three years after the End of Life Choice legislation was passed.
A government review is now due with a number of issues expected to be on the table, including conscientious objection among doctors and some care organisations, and the onus on patients to raise the issue.
The End of Life Choice Act took effect in New Zealand on November 7, 2021, giving terminally ill patients the right to have more say over their own deaths.
The law allows for the application of strict criteria and expert medical evaluation to determine patient eligibility.
Between November 2021 and December 31, 2023, New Zealand’s Assisted Dying Service received 1715 applications and assisted dying practitioners delivered a total of 670 assisted deaths.
It is a statutory requirement that End of Life Choice legislation is reviewed this year.
In a statement to 1News, Manatu Hauora/Ministry of Health said it was "currently engaging with the Government on the terms of reference for the review".
"As indicated in the Government’s coalition agreement, the terms of review will be agreed by the parties,” the ministry said.
Contentious issue
Nearly three years on, End of Life Choice remains a contentious issue in the health sector.
An overwhelming number of Hospice NZ’s members object to the practice of assisted dying – only one hosts assisted deaths onsite.
Conversely, 1News has also spoken to doctors who, despite initial opposition, now support the practice due to their own observations of what the law offers.
The view of Hospice NZ chief executive Wayne Naylor is that health professionals are still "a little uncomfortable about assisted dying".
He says the international palliative care movement has never supported doing things that hasten death.
"We aim neither to hasten nor postpone death so palliative care is its own area of medicine, for want of a better word," Naylor said. "So introducing Assisted Dying goes very counter to that basic philosophy."
The right to conscientious objection is fully supported across the health sector.
However, some question whether this right is affecting patient access to information important for those wanting to explore the option of an assisted death.
Onus on the patient
Under the current law, the onus is on the patient to raise assisted dying for discussion with a health professional.
If that person conscientiously objects, they must direct the patient elsewhere for the help and information needed to make an informed choice.
There’s concern that if that direction is unclear or is not given, patients potentially miss out on information necessary for fully informed consent – a cornerstone of patient care in Aotearoa New Zealand.
Totara Hospice in Auckland is the only hospice in the country that hosts assisted deaths.
Chief executive Tina McCafferty said "organisational conscientious objection" in some facilities, like aged residential care, is denying terminally ill residents access to assisted deaths in what is effectively their own home.
"It’s resulted in patients being ignored, patients being told to go to the funeral parlour – because that’s where they’re going anyway," McCafferty said. "So we want to raise a big conversation around what’s happening with organisational conscientious objection."
Totara Hospice would like to see this and a range of other issues addressed in the upcoming review.
Naylor said, "Hospice NZ is currently surveying its members on how they are working alongside assisted dying".
He said this may shape the organisation’s input into the review.
Health and Disability Commissioner Morag McDowell is monitoring the rights of people using assisted dying services.
A statement from the Office of the HDC says it will provide a submission once the scope of the review has been confirmed.
Complaints raised about assisted dying services
There's concerns some dying patients and whānau aren’t getting the support they need. (Source: 1News)
The Office of the Health and Disability Commissioner has revealed it has received 17 complaints about assisted dying services since the End of Life Choice Act came into force.
HDC Morag McDowell says common themes in the complaints relate to:
- Readiness of facilities to undertake assisted dying services
- Discriminatory attitudes and approaches by some providers towards those seeking an assisted death
- A variable understanding among providers of their obligations when they have a conscientious objection
The tenor of these complaints mirror concerns raised with 1News by a number of health practitioners.
Key concerns relate to requirements for informed patient consent and conscientious objection.
Health sector workers have seen organisational conscientious objection result in patients being forced to find alternative locations for their own assisted deaths. Some have told 1News it "lacks humanity" and adds "unnecessary stress to the lives of seriously patients and their loved ones".
The HDC’s statement said: "The End of Life Choice Act is silent on conscientious objection at an organisational level, and we have discussed this with the Ministry of Health."
The HDC is in close contact with the ministry and will provide a submission once the scope of the upcoming review has been confirmed.
"We also liaise closely with the Registrar (Assisted Dying) and relevant regulatory authorities on complaints about assisted dying," it said.
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