End of Life Care

The End of Life Choice Act 2019 comes into force on 7 November 2021. Under the Act, people who experience unbearable suffering from a terminal illness will be able to ask their doctor for medical assistance to end their lives. This is referred to as assisted dying (AD), that is: ‘the administration by a medical practitioner, or the self-administration by the person, of medication to relieve the person’s suffering by hastening death.’ This article covers the key points from the Act that medical practitioners should be aware of.

In This Fact Sheet:

  • How to determine if a person is eligible for assisted dying.
  • The role of the medical practitioner

 


 

End of Life Care

Is a Person Eligible for AD?

An “eligible” person must meet all of the following criteria:

  • Be 18 years or over;
  • Be a New Zealand citizen or permanent resident;
  • Be suffering from a terminal illness that is likely to end their life within 6 months;
  • Be in an advanced state of irreversible decline in physical capability;
  • Be experiencing unbearable suffering;
  • Be competent to make an informed decision about AD. [This means they can understand information about AD, remember it and weigh it up, and communicate the decision].

NOTE: a person cannot use an ‘advance directive’ to request AD. [An advance directive is a statement signed by a person setting out ahead of time what treatment they want, or do not want, to receive in the future].

Eligibility is not satisfied simply because a person is suffering from a mental disorder or mental illness, has a disability, or is of an advanced age.

Both the medical practitioner treating the person and a second, independent, medical practitioner must consider that the person is eligible. If either or both of the medical practitioners are not satisfied that the person is competent to make an informed decision, a third opinion must be given by a psychiatrist.

If it is determined that the person is not eligible, the process ends.

If the person is eligible, the medical practitioner must advise on, and the person must choose how, they want the medication to be administered. Methods of administration include ingestion or intravenous delivery (triggered by the person), or injection or ingestion through a tube (administered/triggered by the attending medical practitioner).

After the method of administration is chosen, the medical practitioner must ensure the person knows they can change their mind at any time. If a person changes his or her mind or asks for more time before the medication is administered, the medical practitioner must notify the Registrar (Assisted Dying). [The Registrar (Assisted Dying) will be an employee of the Ministry of Health who is appointed by the Director-General of Health].

Before administering the medication, the attending medical practitioner must ask the person if they choose to receive it. The person may use verbal, or non-verbal communication such as gestures, to respond.

While there is no specified ‘waiting period’ between when a request for AD is made and the medication is administered, the above steps will take some time and need to be followed carefully and diligently. A medical practitioner will also need to notify the Registrar (Assisted Dying) when a person makes a request for AD. The Registrar must confirm that all necessary steps have been completed before the medication can be administered.

You may be wondering, am I covered by my NZMII insurance when providing services under the Act?

Yes, absolutely.

The Role of the Medical Practitioner:

A medical practitioner:

Must

  • Consider whether the person is competent to make an informed decision about AD.
  • Inform the person of the irreversible nature of AD and its anticipated impacts, and ensure the person understands alternatives for end-of-life care.
  • Encourage the person to discuss their decision to receive AD with friends, family and counsellors, and ensure they have the opportunity to do so. But importantly, a person is under no obligation to discuss their decision if they do not want to!
  • Ensure the person is aware that they can change their mind at any point, may delay the date of administration by 6 months, or stop the process altogether.
  • Do their best to ensure that the person is not under any pressure from anyone to receive AD, and that the decision is their own. The medical practitioner can do this by talking with:
  1. Other medical practitioners who are in regular contact with the person;
  2. Members of the person’s family (with the person’s permission).
  • Stop the process immediately if it is suspected that the person is being pressured about their decision to receive AD.

May

  • Discuss AD only when the person initiates the discussion themselves (s 10).
  • Opt out of helping a person with AD if they have a conscientious objection

– In other words, if on the basis of your personal beliefs you object to providing end of life services, you do not have to provide them.
– In opting out the medical practitioners must inform the person of their objection, as well as the person’s right to ask for a replacement doctor from SCENZ.

[SCENZ (The Support and Consultation for End of Life in New Zealand Group): SCENZ is to be established by the Ministry prior to 7 November 2021. It will make and maintain a list of doctors, psychiatrists and pharmacists who are willing to be involved in the AD process]

Must not

Initiate any discussion about AD or make any suggestion to the person that they exercise the option of AD under the Act (s 10).

In the next article we take a closer look at the requirement under section 10 of the Act that medical practitioners may only discuss AD if the person initiates the conversation.

 

Current as at 21 July 2021