NEW ZEALAND – End of Life Choice Act – first experiences
24 May 2023
Guest article by Maryan Street*
The New Zealand End of Life Choice Act 2019* in Aotearoa/New Zealand came into force on 7 November 2021. Looking back to the first year , we discover that the Act, with all its cautions, criteria and limitations, is working as intended. The New Zealand Ministry of Health/Manatū Hauora has recently released the results of the first year of the actual operation of the law which so many worked so hard and for so long to bring into force. The report can be found here.
Some statistics
In summary, in the year from 7 November 2021 to 6 November 2022, 661 people applied formally for assisted dying. Of that number, 636 progressed from the initial application to the assessment of an attending medical practitioner. Those 25 who did not progress either withdrew their application, died before the assessment by the attending medical practitioner was formally initiated, were found to be ineligible prior to the first assessment, or their application was still open at the time of compiling the report.
During that period, 636 assessments were completed by the first medical practitioner and 475 completed by the second, independent medical practitioner. 399 were confirmed as eligible and 257 assisted deaths occurred. 305 applications did not proceed to an assisted death either because they withdrew their application, were found to be ineligible or not competent to give consent following the assessment, died from their underlying conditions or because the application was found not to be compliant with the Act at final review.
Much useful data is contained in this report, including ethnicity, age cohort, gender and place of death. Of the 661 new applications received over the year, some details of note are:
– 80.8% were NZ European ethnicity
– 5.5% were Māori
– 55.2% were women
– 75.8% were 65 years or older
– 2.12% were 18-44 years
– 77.0% were receiving palliative care at the time of the application
– 67.9% had a diagnosis of cancer.
The history of the End of Life Choice Act 2019
The original bill was introduced to Parliament in June 2017. It was sent to a Parliamentary select committee for public submissions and consultation and passed finally on 13 November 2019, on the condition that it be subjected to a national referendum one year later, in concert with the 2020 General Election. The referendum clause in the Act also contained a further delay of one year before the Act could be operationalised. The referendum meant that, in total, an additional 2 years since the passage of the Act in 2019 were added to the waiting time before anybody could apply for assisted dying in Aotearoa/New Zealand under the law’s provisions. This has to be one of the longest processes for enacting legislation ever seen in Aotearoa/New Zealand.
In 2020, supporters collectively held their breath for the results of the national referendum which was required before the Act itself could be enacted. The wording of the referendum question was simple:
“Yes, I support the End of Life Choice Act 2019 coming into force.”
“No, I do not support the End of Life Choice Act 2019 coming into force.”
In the end, 65.1% of people supported the referendum and 33.7% opposed it. The turnout of voters in the referendum was 81.9%. This was a very healthy participation rate in the Aotearoa/New Zealand context.
Still more to do…
I had the privilege (and also the pain) last year of being asked to be the primary support person for two friends of mine. The husband had an inoperable brain tumour. I saw the process through with him and his wife, from first assessment by the attending medical practitioner, through the second assessment by the independent medical practitioner and on through to his death, at the time and in the manner of his choosing. It worked just as the process in the Act required and just as the original architects of the Act, a talented group from the End of Life Choice Society NZ and myself, had intended. It was graceful, dignified and peaceful.
Is there more to do? There most certainly is! Compromises were made during the passage of the legislation in order to ensure that at least some form of assisted dying would actually make it through a very conservative Parliament.
A whole section on Advance Directives, binding even after a person had lost the competence to consent, was taken out of the original bill even before it got to the floor of Parliament.
The prognosis period within which one could be eligible was reduced from 12 months to 6, meaning that people were only eligible to apply near the very end stages in the progression of their illness.
Any reference to dementia was removed. Aotearoa/New Zealand is yet to have that social debate on a wide scale.
And critically, one of the criteria for eligibility, namely suffering from “a grievous and irremediable” condition was deleted because the law’s opponents considered it to be too vague and subjective.
The End of Life Choice Society NZ is pressing, with commitment and care, to have all of these compromises revisited and reintroduced. The End of Life Choice Act 2019 is working but it is not yet complete in Aotearoa/New Zealand.
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* HON. MARYAN STREET, formerly a Member of the Aotearoa/New Zealand Parliament, a Cabinet Minister, and a President of the End of Life Choice Society NZ.
** The Aotearoa/New Zealand law allows for 4 methods of administration of life-ending medication, namely: ingestion by the person; intravenous delivery triggered by the person; ingestion through a tube triggered by the attending medical practitioner or attending nurse practitioner; or by injection administered by the attending medical practitioner or attending nurse practitioner. (End of Life Choice Act 2019, Section 19 (2)(a)(i-iv))
