End of Life Choice Act

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.

At the 2020 General Election, New Zealanders had the opportunity to vote in a referendum on whether the End of Life Choice Act 2019 (the Act) should come into force. A majority of voters supported the Act.

The Act gives people who experience unbearable suffering from a terminal illness the option of legally asking for medical assistance to end their lives. However, assisted dying remains illegal until the Act comes into force on 7 November 2021.

The Act outlines the legal framework for assisted dying, and includes controls to ensure anyone who seeks assistance to end their life is making an informed decision of their own accord.

Health practitioners are not required to help a person with assisted dying if they have an objection based on their personal beliefs.

The Ministry of Health will be responsible for the Act and is developing a work programme to implement it. This will include developing policy and preparing guidance for health providers. 

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What is assisted dying?

In the Act, ‘assisted dying’ means: 

  • a person’s doctor or nurse practitioner giving them medication to relieve their suffering by bringing on death; or
  • the taking of medication by the person to relieve their suffering by bringing on death. 

Assisted dying is not a replacement for palliative care or health care services more generally. 

Eligibility for assisted dying

There are strict criteria on who is eligible for assisted dying. To be eligible, a person must meet all of the following criteria:

  • be aged 18 years or over
  • be a citizen or permanent resident of New Zealand
  • suffer 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
  • experience unbearable suffering that cannot be relieved in a manner that the person considers tolerable
  • be able 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.

A person cannot use an ‘advance directive’ to request assisted dying. 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.

Both the doctor treating the person and a second – independent – doctor must agree that the person is eligible for assisted dying. If either doctor is unsure of the person's ability to make an informed decision, a psychiatrist must also assess the person to confirm their eligibility. If the opinion is reached that the person is not eligible, the process ends.

Once the Act comes into force, a person who wishes to receive assisted dying and thinks they meet the eligibility criteria can:

Ensuring an informed choice

If at any time the doctor or nurse practitioner suspects a person is being pressured about their decision to receive assisted dying, they must immediately stop the process.

A number of measures will be in place to ensure the person is making an informed decision and it is their choice:

  • A health practitioner cannot discuss assisted dying unless a person raises it with them first. 
  • The doctors involved in the process must consider that the person is competent to make an informed decision, understands the nature of assisted dying and can communicate their decision. 
  • A person can change their mind at any time up until the medication is administered, and their doctor must ensure they are aware they can change their mind. 
  • The doctor treating the person must encourage the person to discuss their wish for assisted dying with family, friends and counsellors, and must ensure the person has the opportunity to do so. However, a person who chooses to receive assisted dying does not have to discuss their wish with anyone if they don't want to.
  • The doctor must do their best to ensure the person’s decision is free from pressure from any other person by talking with:
    • other health practitioners who are in regular contact with the person
    • members of the person's family approved by the person.

A health practitioner providing a health service to the person may be subject to proceedings by the Health and Disability Commissioner or the Human Rights Review Tribunal if they initiate a discussion about assisted dying.

The role of family 

A person who chooses to receive assisted dying does not have to discuss it with their friends and family if they don't want to. 

However, their doctor must encourage the person to discuss their wish with family, friends and counsellors, and must ensure the person has the opportunity to do so.

Welfare guardians do not have any power to make decisions or take actions in relation to assisted dying.

Health practitioners can opt out

Health practitioners do not have to help a person with assisted dying if they have an objection based on their personal beliefs. 

A Support and Consultation for End of Life in New Zealand (SCENZ) group will be established by the Ministry prior to the commencement of the Act on 7 November 2021. SCENZ will maintain a list of doctors, psychiatrists and pharmacists who are willing to be involved in the assisted dying process.

Medical practitioners who object to being involved with assisted dying must refer the person who has requested assistance to the SCENZ group for the name and contact details of a replacement medical practitioner. 

Methods for assisted dying

An eligible person who wishes to access assisted dying will be asked to choose one of the following methods for receiving the medication:

  • Ingestion, triggered by the person
  • Intravenous delivery, triggered by the person 
  • Ingestion through a tube, triggered by the doctor or a nurse practitioner 
  • Injection, administered by the doctor or a nurse practitioner

When an eligible person has chosen the method for receiving the medication, their doctor must ensure that the person knows they can change their mind at any time. The person may also choose to delay the date they were due to receive assisted dying by up to 6 months.

Before administering any medication, the attending doctor or nurse practitioner must ask the person if they choose to receive the medication. A person who has changed their mind may use non-verbal communication such as gestures to inform the attending doctor or nurse practitioner.

Oversight

The Ministry of Health is responsible for ensuring the Act is implemented appropriately. 

The Act provides for three statutory roles within the health system to oversee assisted dying and make sure the processes outlined in the Act are followed. The three roles are:

  • the Support and Consultation for End of Life in New Zealand (SCENZ) Group
  • the End of Life Review Committee
  • the Registrar (assisted dying).

Read more about oversight of the Act.

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