The Euthanasia Legislation - The End of Life Choice Act
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Parliament has just passed an Act authorising euthanasia (or assisted dying) in limited circumstances. The Act has passed its final reading and become law, but does not come into force unless approved by a majority of the public in a referendum at the time of next year’s election.
The referendum question is a simple “I support the Act coming into force” or “I do not support the Act coming into force”. If a majority supports it, the Act will come into force 12 months after the referendum result.
The act will apply only to people who are:
(a) Over 18,
(b) NZ citizens or permanent residents,
(c) Terminally ill and expected to die within 6 months,
(d) In an advanced state of irreversible physical decline,
(e) Experiencing unbearable suffering that cannot be relieved in a tolerable way, and
(f) Mentally competent to make that decision.
Mental illness, disability or old age alone is not enough.
A person cannot request assisted dying in advance of these assessments (e.g. in a living will), and no-one else can make the decision for them. The criteria for terminal illness and imminent death are to be confirmed by a doctor, and checked by an independent doctor. If there is a doubt about mental competence, that is checked by a psychiatrist. If any of the doctors thinks there is some element of coercion or pressure from another person, the doctors must cancel the process.
Doctors and nurses have freedom to opt out of participating at all for conscientious reasons. But they have to advise their patient of other doctors they could ask.
A doctor cannot initiate a discussion, or suggest or offer assisted dying to a person. But if a patient asks, the doctor must discuss their medical situation and prognosis, and the effects of assisted dying. They must explain other options and advise they can change their mind at any time. If at any time, the patient changes their mind about doing it at all, or about the timing, the doctor must act accordingly and either cancel or reschedule the process. If it is cancelled and the patient changes their mind back, the whole confirming process starts again.
If a patient is eligible and confirms they wish to proceed, there are a number of forms to be filled in and signed by the patient and the doctors. These include the doctors confirming that they have read the medical records and examined the patient and consider the patient comes within the criteria for assisted dying. If the doctors do not consider the patient fits the requirements, they must tell the patient.
If the request is to proceed, the timing and method are discussed with the patient. Again there is advice of the right to change your mind at any time or to defer it, including a check at the time or carrying it out. The options are either oral drugs or injection, carried out by the person themselves or a doctor/nurse practitioner – at the patient’s choice. And a doctor or nurse has to stay in the room or nearby.
All the steps have to be reported by the doctors to a national Registrar who checks the procedures, and is overseen by a Review Committee. There is an annual report on use of the procedures to the Minister and to Parliament. The Act gets reviewed by the Ministry of Health after three years and every five years thereafter, with the report going to Parliament.
When assisted dying is involved, it is an offence to publicise the details, and it will have no effect on any insurance cover. Doctors, nurses and pharmacists who take part in the procedures are protected from criminal or civil liability. But failure to follow the processes can lead to penalties.
Updated: 14 November 2019