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.
The Ministry of Health will be responsible for the Act and has developed a work programme to implement it. This will include developing policy and preparing guidance for health providers.
On this page:
- What is assisted dying?
- Informed choice
- Role of family
- Health practitioners opting out
- Methods for assisted dying
- Implementation and oversight of the Act
- Health practitioners, medical practitioners and nurse practitioners
- Subscribe for updates
‘Assisted dying’ involves:
- a person’s medical practitioner1 (doctor) or nurse practitioner2 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.
Health practitioners, medical practitioners and nurse practitioners have different roles under the Act. An explanation of these roles can be found further down this page: Health practitioners, medical practitioners and nurse practitioners
Criteria in the Act set out 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 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.
Citizens and permanent residents who are overseas can return to New Zealand to access the service.
A person cannot use an ‘advance directive’ to request assisted dying. An advance directive is a statement setting out ahead of time what treatment they want, or do not want, to receive in the future. A person requesting assisted dying must be able to make that decision at the time the request is made.
Both the medical practitioner treating the person and a second, independent medical practitioner must agree that the person is eligible for assisted dying. If either medical practitioner is unsure of the person's competence 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:
- ask a health practitioner* about assisted dying; or
- ask the Support and Consultation for End of Life in New Zealand (SCENZ) group for the contact details of a medical practitioner if they wish to be formally assessed
If at any time the medical practitioner or nurse practitioner suspects a person is being pressured about their decision to receive assisted dying, they must immediately stop the process.
The Act includes a number of measures to ensure the person is making an informed decision and it is their choice to have an assisted death:
- A health practitioner cannot discuss assisted dying with a patient unless the patient raises it with them first. A health practitioner providing a health service to the person may be subject to disciplinary proceedings or proceedings for breaching patient rights if they initiate a discussion about assisted dying.
- The medical practitioners involved in the process must determine that the person is competent to make an informed decision about assisted dying, which includes being able to understand, retain, use and weigh information about assisted dying to make an informed decision about assisted dying, and can communicate that decision in some way.
- A person can change their mind at any time up until the medication is administered, and their medical practitioner must ensure they are aware they can change their mind.
- The medical practitioner 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 medical practitioner 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 person who chooses to receive assisted dying does not have to discuss it with their friends and family if they don't want to. Whether to apply for assisted dying is the patient’s choice. Family members, whānau and welfare guardians do not have any power to make decisions on behalf of a family member.
However, medical practitioners must encourage the person to discuss their wish with family, whānau, friends and counsellors. They must ensure there is opportunity for the patient to do so.
The medical practitioner may speak to members of the patient’s family or whānau as part of the eligibility process, if they have the patient’s permission.
Health practitioners do not have to help a person with assisted dying if they have a conscientious objection.
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 medical practitioners, psychiatrists and pharmacists who are willing to be involved in the assisted dying process.
If an attending medical practitioner is asked to provide assisted dying by a patient and they object to providing the service because they have a conscientious objection, the medical practitioner must inform the patient that they have a conscientious objection, and tell them of their right to ask the SCENZ group for the name and contact details of a replacement medical practitioner.
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 medical practitioner or nurse practitioner
- Injection, administered by the medical practitioner or nurse practitioner
When an eligible person has chosen the method for receiving the medication, their medical practitioner 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 without needing to restart the application process.
The medical practitioner must notify the Registrar if a person changes their mind, withdraws their request, or asks for more time, if this occurs. No further actions to carry out assisted dying are allowed to be taken if the person withdraws their request to receive assisted dying.
Before administering any medication, the attending medical practitioner or nurse practitioner must ask the person if they choose to receive the medication. The person may use non-verbal communication such as gestures to inform the attending medical practitioner or nurse practitioner.
Patients are able to discuss a preferred date, time and location for receiving assisted dying with their medical practitioner.
There is no ‘waiting period’ between when a request for assisted dying services is made and when the medication can be administered. However, there are steps that need to be followed once a request is made, and these will take time.
For example, two medical practitioners need to establish that the patient is eligible. The attending medical practitioner needs to do their best to ensure that the person’s decision is their own, free from any other pressure. This includes talking with other health practitioners who are in regular contact with that person, and members of that person’s family and whānau, if the patient has given permission.
The Registrar for assisted dying needs to be notified of the request. They need to confirm that all the necessary steps are complete before assisted dying can happen. These steps will take time.
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 the programme of work implementing the Act.
A health practitioner is the term for health professionals who are required to be registered and hold a practising certificate, such as doctors, nurses and pharmacists.
Health practitioners are not required to help a person with assisted dying if they have a conscientious objection. All health practitioners are prohibited from raising assisted dying with a patient – this must be raised by the person seeking an assisted death first.
Some types of health practitioners have additional roles that they can perform under the Act.
1 A medical practitioner means a doctor who is registered with the Medical Council of New Zealand, and who holds a practising certificate. Determining a person’s eligibility for an assisted death can only be done by a medical practitioner.
2 A nurse practitioner has advanced education, clinical training and the demonstrated competence and legal authority to practise beyond the level of a registered nurse. The administration of assisted dying medication can only be done by a medical practitioner, or a nurse practitioner.
The Ministry will be providing further information about the implementation of the Act through-out 2021. Subscribe to our newsletter for updates.