HealthInfo Canterbury

Assisted dying

 

Assisted dying is when a person who meets specific criteria under the End of Life Choice Act 2019 is helped to end their own life by taking or being given certain medication. This is done by or in the presence of a doctor or nurse practitioner (a specialised nurse).

Assisted dying is different to choosing beforehand not to receive treatment. For example, choosing not to be resuscitated if you have a heart attack. Choosing not to receive medical treatment ahead of time is covered by an advance directive.

You can't choose to receive assisted dying in an advance directive. You need to be competent to make decisions right up to the point where you're assisted to die.

No one else can make this decision for you, even someone who holds an enduring power of attorney for you or who is a welfare guardian.

Making a request for assisted dying

The first step is to talk to your own doctor about it. Doctors aren't allowed to suggest assisted dying as an option for somebody who is terminally ill, so you have to raise the topic yourself. Nobody else can raise it with your doctor either, it must come from you.

If your doctor objects to assisting people to die (they're lawfully allowed to object and not provide this service), they must tell you and advise you how to contact a doctor who will help.

A list of health practitioners who are willing to provide assisted dying services has been set up. This is called the Support and Consultation for End of Life in New Zealand (SCENZ) Group. You can contact them or your doctor can tell you how to get in touch.

After you've made a request for assisted dying, the doctor must give you certain information. This includes information about your illness and other end-of-life options that may be available to you. They need to encourage you to speak to your whānau (family) and friends or a counsellor, but they must also let you know that you don't have to do this.

The criteria for assisted dying

To be eligible to request assisted dying you must be:

• aged 18 years or older
• a New Zealand citizen or permanent resident
• suffering from a terminal illness that is likely to end your life within six months
• experiencing a serious decline in physical capability that can't be reversed
• experiencing unbearable suffering that can't be relieved in a way you can tolerate
• competent to make an informed decision about assisted dying.

You must meet all these conditions. You aren't eligible just because you're very old or because you have dementia, a mental illness or a disability.

Deciding if you meet the criteria for assisted dying

Two doctors need to make the decision that you meet the criteria for assisted dying. If either or both of the doctors aren't sure if you're competent to make a decision to end your life (the last bullet point above), they will ask for a psychiatrist assessment. Your request will only be moved forward if the psychiatrist decides that you're competent to make an informed decision.

The doctors and, if necessary, a psychiatrist need to be sure you really understand the decision you're making. They will do this by asking you questions to see if you:

• are able to understand the information about what assisted dying means
• are able to remember and consider that information in the decision-making process
• can communicate that decision in some way.

Your doctors also need to be sure that you aren't under pressure from anyone else to make this decision. This may involve them talking to other health professionals who are in regular contact with you. It may also involve them talking to members of your whānau with your permission.

The next steps if you're eligible to receive assisted dying

Your doctor will talk to you about when your assisted death can take place.

There are forms to fill out and the Ministry of Health has to check that everything complies with the law.

Changing your mind about assisted dying

You're free to change your mind at any point in the process right up to when you're about to be given the medication. You can choose to delay the time of assisted dying for up to six months or cancel the request altogether.

How you'll be assisted to die

Doctors and nurse practitioners are the only health professionals able to administer the medication to you or to help you if you want to do this yourself. You can choose the method, date and time.

There are four methods for taking the medication. You can take the medication yourself by swallowing it or taking it intravenously after the doctor or nurse has put a tube into your vein. Or you can choose for the doctor or nurse to administer the medication by injecting it into your vein or giving it to you through a tube inserted through your nose into your stomach. Some of these options may not be suitable for everyone.

Before you're given the medication, the doctor or nurse will ask if you still want to go ahead. If you aren't sure, you can choose to wait and have the medication at another time within the next six months or cancel the request altogether.

If you choose to go ahead and you take the medication or it's given to you, the doctor or nurse practitioner must stay nearby until you've died. They can stay in the same room or in a nearby room or area. You'll be able to have anyone you want with you at the time.

Costs

Health professionals are funded by the Ministry of Health to provide this service, so you don't have to pay. If you have any concerns or questions around costs, talk to your healthcare provider.

Life insurance

Your ability to claim on your life insurance isn't affected by your decision to proceed with assisted dying.

My rights with assisted dying

If you choose to receive assisted dying, you'll be protected by the Code of Health and Disability Consumers' Rights.

These include the right to be treated fairly and with respect, to care and support that meets your needs, to make choices about your care, to discuss your care in a way that you understand and to receive good quality care.

If you feel your rights have not been upheld, you can complain. If you can't sort out your complaint by speaking directly with the person concerned, you have two options. You can contact the Nationwide Health and Disability Advocacy Service (0800-555-050) who provide a free and confidential service and will help you resolve the issue. Otherwise you can contact the Health and Disability Commission to make a complaint.

  HealthInfo recommends the following pages

• Ministry of Health
  • The End of Life Choice Act 2019

    Information about the act.

  • The Support and Consultation for End of Life in New Zealand (SCENZ) Group

    Information about SCENZ, the statutory body for the assisted dying service.

• Te Whatu Ora – Assisted dying accessible and translated information

  Information about the assisted dying service in audio, large print, braille and New Zealand sign language. Information sheets in te reo Māori, Arabic, Cook Island Māori, Hindi, Japanese, Korean, Niuean, Persian, Punjabi, Samoan, Simplified Chinese, Spanish, Tokelauan, Tongan and Traditional Chinese.

• Consumer NZ – Assisted dying: what you need to know about the new law

  An explanation about how the End of Life Choice Act works.

• Health and Disability Commissioner – Assisted dying: people's rights under the code

  A factsheet explaining your rights under the Code of Health and Disability Services Consumers' Rights if you choose to receive the assisted dying service. It includes how to make a complaint if you feel your rights have been breached.

Content shared between HealthInfo Canterbury, KidsHealth and Health Navigator NZ as part of a National Health Content Hub collaborative. Page created August 2022.

Sources

Page reference: 1041018

Review key: HIDLT-326665