End of Life Choice Act 2019


“From 7 November 2021 people who experience unbearable suffering from a terminal illness will be able to legally ask for medical assistance to end their lives.  The introduction of assisted dying means that a person with a terminal illness who meets the eligibility criteria can request medication to relieve their suffering and end their life.  The Act sets out the legal framework and a high-level process for accessing assisted dying, including strict eligibility criteria and safeguards.  Assisted dying is not a replacement for palliative care or health care services more generally. It provides another option for people with a terminal illness in certain circumstances.” - Ministry of Health

Assisted dying is a sensitive subject

Being part of the conversation about such a sensitive and personal subject can be hard. We, as professionals, should recognise this, and use the tools that we have available to manage this.

  • Access your employee support services such as EAP
  • Professional peer support networks
  • Contact your professional organisation
  • Call or text 1737 at any time to speak with a trained counsellor

The Ministry of Health has produced a guide for these conversations, and what to think about potentially before the conversation is begun:

Eligibility 

To be eligible for assisted dying, a person must be: 

  • aged 18 years or over
  • a citizen or permanent resident of New Zealand
  • suffering from a terminal illness that is likely to end their life within six months
  • in an advanced state of irreversible decline in physical capability
  • experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable
  • competent to make an informed decision about assisted dying.
  • A person cannot receive assisted dying solely because they are suffering from a mental disorder or mental illness, have a disability, or are of advanced age. 

Unlike other Acts related to health, competence is not assumed under this Act. If either medical practitioner is unsure of a person’s competence, then the person is referred to a psychiatrist. The process ends if competence is not found. 

Advanced directives or advanced care plans cannot be used for assisted dying.

Obligations for conscientious objectors

You do not have to be involved in providing assisted dying services if you have a conscientious objection.

Regardless of your personal beliefs you should still meet professional standards by not inhibiting someone’s access to lawful medical treatment and ensuring that continuity of care is maintained for a person requesting assisted dying.

If a medical practitioner with a conscientious objection is asked by a patient about assisted dying, they have certain responsibilities under the Act. They must:

  • inform the person of their objection
  • tell the person that they have the right to ask the Support and Consultation for End of Life in New Zealand (SCENZ) Group for the name and contact details of a medical practitioner who is willing to participate in assisted dying.

A person will also be able to contact the SCENZ group directly for help to find a medical practitioner if they do not want to speak with their own medical practitioner about assisted dying.

The Registrar for assisted dying will check that the processes required under the Act have been complied with before the administration of the medication.

SCENZ: The Support and Consultation for End of Life New Zealand Group

The SCENZ group is a statutory body for the assisted dying service It is required to be established under the Act and was formally established on 1 August 2021.

Responsibilities of the group include maintaining the list of medical practitioners and psychiatrists involved in providing assisted dying services; providing contact details for replacement, or independent medical practitioners as part of the service; and providing the contact details for when psychiatrists may be required.

The SCENZ group will support the development of the standards of care for medicines as part of the implementation of the Act being led by the Ministry of health. The SCENZ group will have oversight of the standards and will work closely with the secretariat of the assisted dying service at the Ministry of Health once the assisted dying service becomes legally available from 7 November 2021.

The Standard of care outlines best practice in administering assisted dying medication to ensure safe service delivery for people and whānau.The SCENZ group brings collective experience in the awareness of Te Ao Māori and an understanding of Tikanga Māori; expertise in ethics and law, and the disability sector; and includes representation of the views of patients, whānau and the community.The eleven members are appointed by the Director-General of Health for a term of two years. Membership includes practising medical practitioners, a practising psychiatrist, a practising pharmacist, and a practising nurse practitioner.

Find out more about SCENZ

 

 

Funding

The funding mechanism to pay health practitioners for providing parts of the assisted dying service has been created through a Section 88 Notice (the notice), under the New Zealand Public Health and Disability Act 2000.

Find out more about the Section 88 Notice

Mahitahi Hauora webinar: End of Life Choice Act 

Overview

  • People will be able to request assisted dying from 7 November 2021.
  • A person must raise the question themselves, the medical professional is not allowed to raise first as an option of palliative care
  • A person must meet strict criteria to be eligible for assisted dying.
  • A person must be competent to make an informed decision about assisted dying.
  • Providers of assisted dying services must have the appropriate skills and knowledge to assess, counsel and administer medication – which will provided by the Ministry of Health after an expression of interest is submitted.
  • The process can stop at any time.
  • How the Code of Health and Disability and the End of Life Choice Act interact
  • Discussion regarding aftercare of the whanau and practitioner
  • Examples of how the process will work

E-learning modules

There are three e-learning modules about assisted dying that all health professionals are encouraged to complete. These can be accessed through LearnOnline (registration needed).

  • End of Life Choice Act 2019: Overview – this e-learning module provides an overview of the Act, including a practitioner’s rights and responsibilities.
  • Assisted dying care pathway: Overview – this e-learning module explains the process for accessing assisted dying, including the roles of different health practitioners.
  • Responding when a person raises assisted dying – this e-learning module is to support practitioners to respond respectfully and appropriately when a person raises assisted dying, including best practice communication skills.

A specific care pathway is provided for medical practitioners not providing assisted dying services.

In addition, there are five e-learning modules for medical and nurse practitioners who plan to provide assisted dying services. These cover the assessment process, preparations for an assisted death, assisted death and after-care, and practitioner safety and wellbeing. Practitioners can request access to these modules by emailing eolc@health.govt.nz. Please create a LearnOnline account before emailing, and in the email provide your name, profession, date of birth, email connected to LearnOnline account, Medical or Nursing Council number.

Providers of the service will be required to complete the five e-learning modules to claim funding under the Section 88 notice.

Patient information resources

Printable resources and patient information sheets are available on the Information for the Public page of the Ministry of Health website. The resources include a general information sheet and more detailed information sheets about assisted dying and the steps for a person considering this option. There is also a resource for whānau, carers and support people, and a care plan document.

Patient information resources translated into various languages, and accessible formats such as large print and audio, are available on the Accessible Information for the Public page of Ministry of Health website. 

More Ministry of Health resources

The Ministry of Health has a number of additional resources that practices may want to use to further inform staff. These include:

These are also available through LearnOnline

We will continue to update practices, and this page, as we receive new information.

Further information

For further information, please visit the Assisted Dying Service page of the Ministry of Health website, or email eolc@mahitahihauora.co.nz or eolc@health.govt.nz End of Life Choice Act implementation programme team.