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Source: Kai Tiaki Nursing New Zealand November 2020
The New Zealand Nurses' Organisation will start drawing up guidelines for nurses over the next 12 months on how to work within the new end-of-life law next year.
In last month's referendum, 65 per cent voted in favour of the End of Life Choice Act, which will come into effect in November 2021. NZNO policy adviser Sue Gasquoine said now the act would become law,
NZNO would be launching a research project among members, subject to ethics approval, on what clinical practice support nurses in Aotearoa New Zealand needed when nursing people at the end of life.
The research findings would inform a member survey, the responses to which would then form the basis of a national nursing framework.
"A valid framework for Aotearoa New Zealand would need to support nurses work-ing in 'mainstream' end-of-life care and practising te ao Māori," Gasquoine said.
NZNO had not taken a position on end-of-life legislation, but would support its members to work within the law. That included opting out of providing end-of-life care, which was provided for in the act, Gasquoine said.
"NZNO's stance on the bill, and now the act, is that while there are members representing the full spectrum of views on end-of-life choice, the concern is to support members to work within the law as they care for patients and their whānau who are making choices about end of life."
Following NZNO submissions in 2018, nurse practitioners were included among health practitioners who would provide care for people who choose to use the act to end their life, Gasquoine said.
NZNO hoped to lead or collaborate with organisations such as the Ministry of Health, Nursing Council, College of Nurses Aotearoa and medical colleges to develop guidelines for practitioners. It was also important to brief incoming Minister of Health Andrew Little on the need for nursing input as the Government prepared to implement the act over the next 12 months, she said.
NZNO acting associate professional services manager Kate Weston said nurses must "absolutely" be represented on the Support and Consultation for End of Life in New Zealand (SCENZ) group. SCENZ will keep records of health professionals willing to participate in assisted dying, maintain standards of care, and provide legal, medical and practical advice to health professionals.
"Some may be prescribing, but for most it will be in providing the actual care and we must have a voice in what this looks like," Weston said.
By Eva Corlett of RNZ
Doctors are gearing up for a hefty year of planning and preparation with the End of Life Choice Act set to come into force.
The preliminary referendum result shows 65.1 percent of voters supported the act and 33.8 percent opposed it.
Assisted dying remains illegal in New Zealand until November 6 2021.
The New Zealand Medical Association (NZMA) opposed the law, but its chair Kate Baddock said the country had spoken.
"It now behooves the NZMA to work with its doctors and with the public to ensure that everybody understands just what the act will entail and what people's obligations, responsibilities, and options will be."
The law allows doctors to be conscientious objectors of euthanasia.
One of the first steps will be creating a list of which doctors are happy to be part of the process, Dr Baddock said.
"Doctors will be making their choices well before the 12 months are up as to how they feel about being engaged - first of all in the process of decision-making and then the execution of the medication itself."
There is a lot of uncertainty over what the next year will entail, she said.
"It's going to be really important as an organisation that we engage with our membership over what the provisions of the law mean. So as a doctor, what does it mean precisely in terms of your responsibilities and your options."
The Royal College of General Practitioners took a neutral stance on the issue. President Samantha Murton said it will advise and support its members through the transition.
"There'll have to be training and learning about the legislation, how it works, what your requirements are, what you do if you think someone is under coercion, how do you access the services if you don't want to do it yourself."
Dr Murton said there will also be a lot of planning around logistics.
"There might be places where you don't have two doctors to be able to provide the services in a particular centre, there may be logistics around that.
"It's just making sure all the checks and balances are in place and that the system's very robust and people know how to access the services if they want it," she said.
There's a huge amount of ground to cover in a year, she added, and implementing the law will need "extremely good management".
Many of those who choose to access euthanasia will be terminal cancer patients.
The Cancer Society also remained neutral on the issue but its medical director Chris Jackson said the society will support people no matter their decision.
"It's important that people who want to pursue [the] end of life choice can achieve that, as required under the law, and the Cancer Society will be neither obstructing nor encouraging but we will be supporting people in every way, shape and form we possibly can."
The referendum results show people "heavily reject" the idea of suffering at the end of life and that means everyone needs access to good end of life care options, Jackson said.
"I would never want to see anyone presented with the false choice of either suffering or assisted dying because that is not the choice that should be available to people. It should be excellent supportive care with all possible efforts to relieve suffering made in all cases, at all times.
"We're currently not there, so we need to make sure that funding is there to do that, that the laws are there to allow carers to take time off work and the like, and if we don't do that, we're letting people down," he said.
There are still half-a-million special votes to be counted in the referendum, with final results due on Friday.
A euthanasia advocate says New Zealanders should be very proud of Friday's preliminary referendum results which saw victory for the End of Life Choice bill.
Matt Vickers, widower of Lecretia Seales, a prominent advocate for euthanasia while terminally ill with brain cancer in 2015, says his wife would be very proud.
At the time of her death at 42, she was paralysed and unable to speak
The Wellington lawyer took the government to court over her wish to legally end her life.
She died in 2015, a day after a High Court judge ruled against her.
Watch the interview on The AM Show »
Together we have achieved a victory for the End of Life Choice Act 2019 in New Zealand. Now all the ballot box votes have been counted our success is overwhelming 65.2% YES while the no vote was half that – 33.8%.
Our members and supporters are responsible for the hard work that was needed to stem the tide of misinformation churned out by our opponents. We thank you all for your ideas, efforts, and enthusiasm.
Now we have one year to wait while the Director-General of Health takes 3 main steps:
There are plenty more issues that will involve guidance from the Medical Council but by November 6th 2021, terminally-ill Kiwis will be able to ask their doctors for compassionate release from unbearable suffering.
As his final words on Friday David Seymour said: “What a wonderful day to be a New Zealander”.
While we're still waiting on special votes to be counted, preliminary results from the euthanasia referendum make it clear assisted dying will soon be legal in New Zealand.
The referendum on the End of Life Choice Bill - which gives people with a terminal illness the option of requesting assisted dying - was held alongside the general election and cannabis legalisation and control referendum earlier this month.
Preliminary results released by the Electoral Commission on Friday afternoon show 65.2 percent of Kiwis are in support of bringing the End of Life Choice Act 2019 into force, with 33.8 percent against.
Here's what that means for New Zealand.
The referendum, held between October 3-17, was a vote on whether the End of Life Choice Act 2019 should become part of New Zealand's legislation.
Parliament had already passed the End of Life Choice Act, but it wouldn't come into force unless the majority of Kiwis were in favour of it.
New Zealanders were asked "Do you support the End of Life Choice Act 2019 coming into force?" and were given the option of answering 'yes' or 'no' to the question.
As the referendum is binding, the Act is guaranteed to come into effect if more than 50 percent of Kiwis voted in favour.
The positive result announced on Friday afternoon means people with a terminal illness will soon have the option of requesting assisted dying.
The End of Life Choice Act will become enshrined in law a year to the day from when the final referendum results are announced.
Final results will be revealed by the Electoral Commission next Friday, November 6, when special votes have been counted. Special votes are those from people who enrolled on election day or cast their ballots from overseas.
That means Kiwis could only begin the process of applying for assisted dying from November 6, 2021.
Until then, euthanasia will still be considered "aiding and abetting suicide" under Section 179 of the New Zealand Crimes Act 1961.
Once the End of Life Choice Act becomes law, Kiwis will be eligible for assisted dying so long as they:
Are aged 18 years or over
Are a citizen or permanent resident of New Zealand
Suffer from a terminal illness that's likely to end their life within six months
Have significant and ongoing decline in physical capability
Experience unbearable suffering that cannot be eased
Are able to make an informed decision about assisted dying
Those considered able to make an informed decision about assisted dying are those who can understand the information, remember it, weigh it up and communicate their decision in some way.
The Government says people will not be eligible for assisted dying if the only reason they give is that they are suffering from a mental disorder or mental illness, have a disability of any kind, or are of advanced age.
In the case of a request for assisted dying, the physician in charge must do their best to ensure it's the person's own choice.
"If, at any time, the doctor or nurse practitioner thinks a person is being pressured about their decision, they must stop the process," Government information reads.
"A health practitioner is not allowed to suggest that a person consider assisted dying when providing a health service to them."
The process for assisted dying begins with a person asking their doctor for it.
The doctor - alongside another, independent physician - must then agree that the person meets the criteria stated above. If either doctor is unsure, a psychiatrist must assess the person.
If the person is eligible, they are able to choose a method, date and time for their death.
At the time the person has chosen, the doctor or nurse practitioner gives a lethal dose of medication, and remains available to the person until they die.
A person who's requested assisted dying can change their mind at any time.
The doctor or nurse practitioner at hand must ask the person if they still want to go ahead just before the medication is administered.
If they do, they can choose one of four options for how they wish to receive assisted dying medication.
Ingestion, triggered by the person.
Intravenous delivery, triggered by the person.
Ingestion through a tube, triggered by the attending doctor or nurse practitioner.
Injection, administered by the attending doctor or nurse practitioner.
If they don't, the medication must be taken away.
"No particular form of words is required to be written or said by the person to show they have changed their mind," the Electoral Commission says.
"The person can use gestures to communicate to the attending doctor or nurse practitione. The person can also choose to delay the date to receive assisted dying by up to six months."
Opting for euthanasia will not affect a person's life insurance. A person who dies as a result of assisted dying is taken to have died from the terminal illness from which they suffered, as if assisted dying had not been provided.
A doctor can object to providing assisted dying if they have a conscientious objection to the procedure. However they must tell the person they have a right to ask for the name and contact details of a replacement doctor.
A person does not need to discuss their decision to opt for assisted dying with their family. However, their doctor must encourage the person to discuss their wish with family, friends and counsellors, and must ensure the person has the opportunity to do so.
A welfare guardian cannot make decisions about assisted dying on behalf of a protected person.
Advance directives - a statement signed by a person setting out ahead of time a treatment wanted, or not wanted, in the future - are not permitted when it comes to assisted dying.
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