By End-of-Life Choice Society President, Ann David

The Ministry of Health speaks

The statutory review of the operation of the End of Life Choice Act (2019) has now been published by the Ministry of Health. This marks three years of operation of assisted dying in our country.  The Ministry made 25 recommendations, 8 of which are exactly in line with those of the End-of-Life Choice Society NZ.

The Ministry recommends:

  • The removal of the ‘gag’ on doctors’ raising the topic of assisted dying when relevant.
  • Making it much harder for conscientious objectors, individual or organisational, to obstruct people wanting to apply for assisted dying.
  • Allowing nurse practitioners to undertake all assisted dying roles up to and including the role of AMP or first doctor.

Remaining recommendations were made to clarify the Act where it was previously silent. This would have the beneficial effect of removing all doubt about the legal process.

Will the recommendations be taken up?

According to Health Minister Dr Shane Reti, this is “not the government’s priority”.  He has left any potential change to the End of Life Choice Act to the vagaries of a private Member’s bill. This is the most arduous route of all for legislation and the least likely to succeed.

The Ministry of Health was not permitted to make any recommendation to the currently extremely restrictive eligibility criteria. That was outside its terms of reference. Unfortunately this is the greatest obstacle of all not tackled by the review.

The End-of-Life Choice Society’s viewpoint

In our experience, the greatest barrier to accessing assisted dying is the requirement for the person to be “terminal” and “likely to die within 6 months”. 

 Doctors freely acknowledge that prediction of time-to-death is difficult, often inaccurate and sometimes impossible. Insisting on a prediction of “time-to-death” is therefore unfair and has the effect of discriminating against those with diseases that are impossible to predict.

Examples of diseases where time-to-death is mostly unpredictable include Parkinson’s, multiple sclerosis, dementia, motor-neurone disease, Ehlers-Danlos syndrome, end-stage heart and end-stage lung disease. Sufferers of these incurable diseases find it almost impossible to qualify for assisted dying, no matter how great their suffering and no matter how advanced their irreversible physical decline.

Proposed amendment

The End-of-Life Choice Society would like to replace the “6-month” requirement with a requirement for the person to have a “serious and incurable medical condition likely to lead to death”, but without specified timeframe.  In this, we would be following a number of jurisdictions notably in The Netherlands, Belgium, Luxembourg, Spain, Canada and the Australian Capital Territory. 

All other eligibilty criteria should remain the same

The following are currently part of the medical eligibilty criteria and should remain exactly as they are. They require that the person applying for assisted dying be:

  • experiencing unbearable suffering that cannot be relieved in a manner tolerable to the person, and
  • in an advanced state of irreversible decline in physical capability.

At least 75% of applicants for assisted dying are receiving palliative care at the time of applying.

Assisted dying law should be fair, compassionate and non-discriminatory

The End-of-Life Choice Society is New Zealand’s only advocacy organisation for the right to die with dignity. Its members are grassroots citizens from every walk of life. We advocate for a human rights-based approach to assisted dying law.

We support increased funding for palliative care. Working alongside assisted dying, this can provide a continuum of care for the person and their whānau, where desired.