The Ministry of Health’s programme of work is well underway to implement the End of Life Choice Act 2019 (the Act) and establish an assisted dying service in New Zealand.
Assisted dying services will become part of the existing health and disability system and there will be continuous quality improvement activities. It will be important to ensure the service puts people and their whānau at the centre, uses effective safeguards, and is accessible to those who meet the criteria under the Act.
The implementation programme aims to ensure that on 7 November 2021:
- medical and nurse practitioners who offer to provide assisted dying services to eligible people are trained and available
- the wider health workforce is aware of the Act, their obligations under the Act, including the right to conscientious objection
- the statutory bodies and roles set out in the Act are established. These are the Support and Consultation for End of Life in New Zealand (SCENZ) group; the Review Committee and the Registrar (assisted dying)
- administrative systems, regulations, and professional guidance, information and supports are in place; and
- public information about the assisted dying service is available and health practitioners can provide information to people about the SCENZ group if appropriate.
Assisted dying will be an entirely new service within the health and disability system. It is not a replacement for palliative care or health care services more generally. It provides another option for people with a terminal illness in specific circumstances.
For more information about implementation steps visit the Milestones section.
Delivery of assisted dying services
Assisted dying will be publicly funded in New Zealand and the Ministry will be responsible for overseeing the funding and provision of assisted dying services.
Any medical or nurse practitioner who is suitably qualified, and willing to do so, will be able to provide parts of the assisted dying process.
Assisted dying services involve:
- supporting someone who is terminally ill to make an application for assisted dying, and undertaking a first assessment. This is done by an attending medical practitioner
- undertaking a second independent assessment. This is done by a second medical practitioner
- a third assessment by a psychiatrist may be undertaken, if one or both of the initial assessments was unable to determine that the person is competent to make a decision
- confirming that someone is eligible for assisted dying
- provision of the assisting dying service, by the attending medical practitioner or an attending nurse practitioner under their supervision.
Medical practitioners and nurse practitioners working in primary care, private practice and other non-DHB settings who provide parts of the service can receive funding on a fee for service basis for the parts of the process they provide. Details related to this funding are being developed.
Assisted dying services are most likely to be provided in a person’s home or other community settings, rather than in hospital settings. A person’s medical or nurse practitioner will be able to travel to the person to provide care and will be funded for travel costs.
If a practitioner is providing services as part of their employment within a district health board (DHB), DHB funding will cover these costs where the services are provided in the DHB setting.
In some situations, a person may live somewhere where it is not possible or appropriate to provide assisted dying services. If this happens, then a person’s medical practitioner with the support and guidance of the assisted dying service secretariat at the Ministry of Health, will provide advice on what options the person may have.
If a person requests assisted dying from a medical practitioner who does not provide assisted dying services due to a conscientious objection, the medical practitioner is legally required to:
- inform the person of their objection
- tell the person they have the right to ask the 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 to their own medical practitioner about assisted dying.
The Registrar (assisted dying) will check that the processes required by the Act have been complied with before the administration of assisted dying medication.
As with other health services, practitioners need to have the right skills and knowledge to be able to provide assisted dying services.
For more detailed information:
- Cabinet paper and decisions on the delivery of assisted dying
- Information sheet on funding and delivery model for assisted dying services
- Implementation resources, including the latest information sheets
- Statutory bodies, including SCENZ.
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.
More information about the notice for the assisted dying service can be found here:
The Ministry has work underway to ensure appropriate medicines are available.
The medicines to be used for assisted dying are safe and effective medicines. Use of these medicines for assisted dying is what’s is referred to as an ‘off-label’ use. That means a medicine is prescribed for an indication or a patient group that is not included in the product information. Prescribing off label is very common.
For safety reasons the detail of the medicine regimes will only be provided directly to the practitioners providing the service. Details and names of the medicines will not be made publicly available due to restrictions on promotion and legislative criteria.
Budget 2021 provides $11.860 million in 2021/22 to support the implementation of assisted dying and ensure the necessary processes, safeguards, controls, monitoring and oversight are in place to enable assisted dying services to be available from 7 November 2021.
Oversight and monitoring will include the SCENZ group, and the End of Life Review Committee. These statutory bodies are in the process of being established. The Registrar (assisted dying) will be appointed later in the year.
Budget 2021 funding will also support the Ministry to develop and maintain information for the public and support a workforce of trained practitioners that may include general practitioners, oncology specialists, palliative care specialists, psychiatrists, and nurse practitioners.
Te Tiriti o Waitangi
Te Tiriti o Waitangi in relation to health and disability services is considered and incorporated at every phase of the implementation programme, and the commitment to support a Māori worldview of health and ensure quality (culturally and clinically safe), equitable, and effective services for Māori.
The implementation programme team meets a range of Māori health and disability organisations as part of the design and implementation of the assisted dying service. This includes Māori led primary health organisations and Māori health providers with general practitioner practices.
Te Apārangi: Māori Partnership Alliance will provide guidance, direction and recommendations on the programme. Te Apārangi members include health and disability service providers, researchers and sector experts.
Te Apārangi currently provides oversight and guidance on the implementation of the updated Health and Disability Services Standard (the Standard) to the Ministry.
For more information visit Te Tiriti o Waitangi and assisted dying implementation.
Engagement to inform equity and accessibility of assisted dying services
Wide engagement with the health and disability sector continues as part of the implementation of assisted dying services. This includes with the disability sector, Māori led primary health organisations, Pacific primary health organisations, professional colleges, councils, unions, and other health organisations.
Training for health professionals
A key part of the Ministry’s implementation work is providing training, information and guidance for health professionals to support preparation for the introduction of assisted dying services.
To find the details of the training, and information sheets, see the learning information in the Implementation resources section.
Development of the care pathway
The care pathway identifies the journey a person moves through when they request and are eligible for assisted dying.
The purpose of the care pathway is to inform eligible people and also to inform medical practitioners of the steps, or sequence of clinical interventions; the consultation points; processes; and timeframes for the service.
The Ministry is designing the care pathway for assisted dying with inputs from sector specialists and partners including General Practitioners, nurse practitioners, psychologists, palliative care practitioners, and pharmacists.
A public version of the care pathway will be available as part of the information available on 7 November 2021, when assisted dying becomes legally available in New Zealand.
Number of people expected to seek access to the service
The number of people that may seek assisted dying is expected to be small. In overseas jurisdictions of Victoria, Oregon, and Canada, assisted dying accounts for between 0.3 percent and 2 percent of all deaths. Based on overseas experiences, the Ministry estimates up to 950 people could apply for assisted dying each year, with up to 350 being assisted to die.
There is uncertainty about what the actual demand will be, given that this has never been provided in New Zealand before, and that the rules for assisted dying are different in other jurisdictions.
Assisted dying is a sensitive topic and may be difficult for some people. If reading this information has raised some distressing feelings for you, please know there is support available. You can call or text 1737 for free to speak to a trained counsellor at any time.