- The End of Life Choice Act 2019 (the Act) gives people who experience unbearable suffering from a terminal illness the option of legally asking for medical assistance to end their lives.
- The Act outlines the legal framework for assisted dying, and includes controls, eligibility criteria and safeguards. A person who seeks assisted dying must be making an informed decision of their own accord.
- The Act will come in to force 12 months after the public referendum held at the 2020 General Election.
- Assisted dying remains illegal until 7 November 2021.
On this page:
- What is assisted dying?
- Informed choice
- Health practitioners opting out
- An eligible person has some decisions to make about their assisted death
- A person can change their mind at any time
- Role of family
- Whānau can support their loved one through the assisted dying process
- Health practitioners, medical practitioners and nurse practitioners
- The role of nurses and nurse practitioners
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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.
Under the Act ‘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.
Note: 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.
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.
Further information on this can be found in the information sheet for health practitioners at Implementation resources.
If a person is eligible for assisted dying there are several decisions for them to make.
- A person will choose a date and time for the medication to be administered.
- Once a person has chosen the date and time for the administration of the medication, they can also choose to delay this date for up to six months from the date originally chosen. Delays longer than six months are possible, but will mean a person has to reapply for assisted dying.
- A person will choose the place they want to be when the medication is administered, such as in hospital or at home. They can also choose if they would like whānau or other people present.
- A person will choose how they would like the medication to be administered. They can choose to self-administer the medication (in the presence of a medical or nurse practitioner). They can also request that a medical or nurse practitioner administers the medication.
It is important to note that some options may not be appropriate or possible depending on a person’s condition. In those cases, a person’s medical or nurse practitioner will be able to provide advice about a person’s options.
If a person changes their mind about choosing assisted dying, they can stop the process at any time up until the point that the medication is administered. The medical practitioner must explain that they can change their mind as part of the assessment process.
Before the medication is administered, the medical or nurse practitioner will ask the person if they choose to receive the medication. The person can choose to take the medication then, delay taking the medication to a later date (within six months of the date originally chosen), or cancel their request for assisted dying.
If during any stage of the process it is found that the person is not eligible, such as if they are not considered competent to make an informed choice, the medical or nurse practitioner must stop the process and explain the reason the process has stopped to the person.
The medical or nurse practitioner must also stop the process if coercion is suspected.
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.
Whānau and carers can play an important role in supporting someone through the process, if the person seeking assisted dying wishes this. This could include:
- helping someone understand and consider their end-of-life options
- attending medical appointments with someone (a medical practitioner may want to speak to the person on their own first)
- providing personal care, such as bathing and feeding
- offering care and support when the medication is administered.
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 Act specifies roles for health practitioners related to the provision of assisted dying.
It is acknowledged that the scope of practice for nurse practitioners is restricted under the Act. The Act requires assessments to determine eligibility for assisted dying to be undertaken by two medical practitioners (and a psychiatrist if there is uncertainty about whether someone is competent to request assisted dying).
Nurse practitioners can be involved in the planning of assisted dying with the person and their whānau, and can be with the person to administer medicines or supervise self -administration if that is what the person chooses.
Nurses and nurse practitioners provide ongoing care of people at critical times in their lives and it is anticipated that nurses who choose to would continue to provide support and wider care for a person who may choose to seek assisted dying.
The Act is the product of a private member’s Bill, and includes a clause requiring that it is reviewed by the Ministry within 3 years (by November 2024) and every 5 years after that. A review of how the Act is being implemented will take place after a year.