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  • 02 Dec 2022 11:49 AM | EOLC Admin (Administrator)

    Source: Go Gentle Australia


    Yesterday  the Australian Senate passed the Restoring Territory Rights Bill, overturning a 25-year ban on the Northern Territory and ACT debating their own Voluntary Assisted Dying (VAD) laws.

    The bill passed on the voices. Finally, the NT and ACT can make up their own minds on VAD - rather than federal powers deciding for them.

    This rights a historic wrong. Back in 1995, the NT bravely passed the world’s first compassionate euthanasia law. However, when the Commonwealth heard, a small group of well-organised, anti-choice politicians set about overruling the NT’s law and gagging both territories on the issue. 

    The 25-year fight to restore Territory Rights has been one of the most vexing for end-of-life choice in Australia, but also one of the most rewarding. Politicians from across the political divide - not all of whom support VAD - have come together to respect the democratic rights of 700,000 Territorians. 

    Every Australian state has now passed a VAD law; it is only right that the NT and ACT have the choice to do the same.

    Our heartfelt thanks to

    Supporters like you, for sharing testimonies, contacting MPs, signing petitions and making your voices heard;

    Marshall Perron, former NT chief minister and architect of the NT’s original euthanasia law, for his continued fight for Territorians’ self-determination long after he left politics;

    Judy Dent, whose husband Bob was one of just four people to use the NT’s law before it was overturned, for never wavering in her pursuit of justice;

    Northern Territory Voluntary Euthanasia Society and Dying With Dignity ACT, led by Judy Dent and Jeanne Arthur respectively, for leading Territory Rights campaigns for decades;

    Tara Cheyne and the ACT Legislative Assembly, for keeping the spotlight on this issue;

    The Australian Greens for their steadfast support for Territory Rights and voluntary assisted dying over many decades;

    Federal Labor MPs Alicia Payne (ACT) and Luke Gosling (NT) for drafting and introducing this bill in the House of Representatives;

    Long-time proponent ACT Senator Katy Gallagher and her colleague Senator David Pocock, for using every avenue to ensure a final vote happened this year;

    And all MPs and Senators for supporting the rights of Territorians to decide for themselves about their own lives and deaths.

    Together, we have shown our federal parliament their overreach would no longer be tolerated by the Australian people.

    What's next?

    Since the Lower House already backed the Restoring Territory Rights Bill 99 votes to 37, it now becomes law.

    However, VAD is not yet legal in the NT and ACT. Their Legislative Assemblies must now debate whether to pass their own laws, as every state has had the opportunity to do. 

    This is a long-overdue but significant step towards compassionate, end-of-life choice for all Australians.


  • 07 Nov 2022 12:58 PM | EOLC Admin (Administrator)

    The right to “assisted dying” is bringing a sense of relief to many New Zealanders. But one year on from its introduction, there is frustration over the law’s tight confines.

    by RUTH NICHOL ● photograph by HAGEN HOPKINS (NZ Listener November 2022)

  • 02 Nov 2022 10:23 AM | EOLC Admin (Administrator)

    There are many forces that differentiate us in the world: politics, religion, beliefs to name only a few. One thing that unites us is the desire to die with dignity. Asunción Alvarez, president of the World Federation of Right to Die Societies said, “Around the globe, many people fight to make a death with dignity possible for themselves and those they love. It is these people that we would like to put in the spotlight for World Right to Die Day 2022; the Champions, who through their support, activism, fighting, writing, willpower, vision and strength, are advocating to make right to die legislation possible all over the world.”

    Champions such as New Zealand’s Dr Libby Smales from the Hawkes Bay and the late Esther Richards from Tauranga.

    As a retired palliative care consultant and former hospice director, Libby allowed herself to be co-opted by TV programmes on national and regional channels during the 2020 referendum year, staring down official palliative care spokespersons and an Opus Dei lawyer with that most uncomfortable weapon: the truth. “Wonderful as it is”, she said, “palliative care is neither infallible nor sufficient in all circumstances.”

    During the last increasingly difficult months of her life, Esther Richards permitted a documentary film crew to follow her assisted death so that the resulting current affairs programme could inform others. On TV she said, “I don’t want to die as someone other than me”. She remained Esther to her last breath.

    At 18.30 local time on November 2nd, the End-of-Life Choice Society NZ will post the World of Champions map on www.eolc.org.nz as will all 58 World Federation of Right to Die Societies spread through 30 countries across six continents. Rob Jonquière, Executive Director said, “The World of Champions tells the stories of the parents, siblings, activists, doctors, supporters and volunteers who are working to make dying with dignity possible from all the corners of the earth. It is a testimony of their struggle and the complexities they face in championing the right to die with dignity. In some areas, the map is empty, and while there are certainly Champions in each of these countries, their efforts are shrouded in silence without right to die societies to support their cause and tell their story. We hope that they will join us in time.”

    At the biannual World Federation Conference of Right to Die Societies in Toronto, Canada, WFRtDS president Asunción Alvarez will unveil the World of Champions map at a special presentation at 18.30 (EDT)and discuss the achievements of our Champions thus far in 2022 and the challenges we face in 2023.

    Join us in celebrating the unity and commitment of Champions worldwide on November 2nd, World Right to Die Day, by reading and sharing their stories as well as joining us in supporting their advocacy.

    See the End-of-Life Choice Society NZ www.eolc.org.nz Our organization has been fighting since 1979 to obtain and defend the right to die with dignity for New Zealanders whose incurable medical conditions cause them intolerable suffering that cannot be alleviated.

    The World Federation of Right to Die Societies’ goal is to ensure that everyone has the right to die with dignity, peacefully and without suffering. Founded in 1980, the federation comprises 58 right to die organizations from 30 countries and facilitates the cooperation between member societies to utilize the experience and expertise of professionals already lawfully assisting people to die. For more information, please visit www.wfrtds.org ENDS

    ENDS

    In NZ, contact Ann David, President End-of-Life Choice Society. +64 27 573 8085 ann.david@outlook.co.nz

    Internationally, contact World Federation of Right to Die Societies janebarrett@worldrtd.net +31.6.47594091


  • 02 Jul 2022 1:02 PM | EOLC Admin (Administrator)

    Opinion by Ann DavidEnd-of-Life Choice Society president

    Source: Gisborne Herald

    Ahead of the release today of the Assisted Dying Registrar’s first report to Parliament, the End-of-Life Choice Society highlights information that has come to it from members of the public using the service.

    Praise flows for the clinical advisers at the coalface of the Assisted Dying Service, for their efficiency and sensitivity. They handle all the necessary communications with and between doctors, specialists, psychiatrists and patients. In two instances known to us, applicants who were bitterly disappointed to be found ineligible say they were nevertheless counselled with warmth and compassion by their clinical advisers.

    As expected, even more generous praise flows for the assisted dying doctors. The parent of an assisted dying patient described the death as “surreal and sort of beautiful”. She was living in an urban rest home but “didn’t want to die in a room”. Family and friends arranged to transport her to a chosen outdoor setting. Facing a beautiful bush view, she embraced loved ones for the last time. When she signalled readiness, the assisted dying doctor stepped forward. The patient had chosen to take the medication orally. Within minutes she fell into a sleep from which she never awoke. She had avoided a prolonged and gruelling death, remaining instead in personal control to the end.

    While most assisted dying patients choose to die in their own bed at home, a North Island patient wanted to farewell the animals on his land one last time. Then when he was ready, he took the life-ending medication from his doctor waiting close by. His hospital death would have been harrowing for him and his family; his suffering unable to be relieved in spite of excellent care. Instead, his assisted dying doctor went above and beyond to make death peaceful and personally meaningful for him.

    An End-of-Life Choice Society member shared with us a comprehensive, user-friendly booklet given to assisted dying applicants like herself outlining next steps and recommending actions for finishing unfinished business. “My assisted dying doctor couldn’t be nicer,” she said.

    But it’s not all roses. There are obstructions, whether deliberate or unintentional. When a patient’s own doctor declines to help, the law requires that doctor to tell the patient they can seek assistance from “SCENZ”, the newly-created statutory body within which the Assisted Dying Service operates. But the law does not actively require declining doctors to provide the relevant contact details of SCENZ, so some choose not to.

    Their frantic patients may or may not find their way to the End-of-Life Choice Society’s “Contact Us” page. To those who have, the society provides the 0800 Assisted Dying number that features on our website and then follows up a few days later to make sure the patient has been attended to. They always have been and they are always enormously relieved. Clearly, just knowing help is at hand is palliative to a dying sufferer.

    Of the 33 hospices that fall under the Hospice NZ umbrella, only two allow assisted dying onsite. The End-of-Life Choice Society thanks Totara Hospice in Auckland and Cranford Hospice in the Hawke’s Bay for their enlightened leadership and for upholding the hospice philosophy of respecting patient autonomy and of caring for patients non-judgmentally. We are gratified to know that 80 percent of assisted dying patients are in palliative care at the time of requesting assisted dying.



  • 19 May 2022 3:48 PM | EOLC Admin (Administrator)

    Source: Go Gentle Australia

    At last! After 50 years of tireless advocacy, the Voluntary Assisted Dying Bill 2021 has passed NSW Parliament. 

    The Lower House voted the Bill into law after the Upper House also approved the Bill with just a handful of amendments.

    This is a revolution in end-of-life care, and an evolution in compassion.

    Terminally ill people in NSW finally have a choice not to suffer - like Australians in every other state.

    The law will come into effect in 18 months time.

    This celebratory moment is also tinged with sadness as we remember the many individuals, loved ones and carers for whom this law did not come soon enough.

    NSW has been the toughest battle yet. It is testament to the tenacity of supporters like you that we have made history today.

    Whether you shared a testimony, contacted your MP, signed a petition or took to the streets with placards - today's success is a culmination of individual actions that formed an unstoppable groundswell. Thank you for your support.

    Our heartfelt thanks to:

    The people facing terminal illness who gave up their precious time to advocate for this law, some of whom are no longer with us: Judith Daley (deceased), Siobhan O’Sullivan, Sara Wright, Belinda Ryan (deceased), Mark Butler, Janet Cohen, Scott Riddle, Loredana Mulhall (deceased), Annie Gabrielides (deceased), Lawrie Daniel (deceased) and Tim Edwards (deceased);

    The many family members who participated in the They Died Waiting campaign;

    Alex Greenwich, the Independent Member for Sydney, and his policy advisor Tammie Nardone, who drafted and championed this Bill and did so much to ensure its success. Their compassion, commitment and sense of justice were unparalleled;

    Adam Searle, the Labor MLC who took carriage of the Bill in the Upper House and whose skilled advocacy steered the Bill through a deluge of last-minute amendments;

    All 28 co-sponsors of the bill whose collaboration showed politics at its best;

    Dying with Dignity NSW, led by the inimitable Penny Hackett and Shayne Higson, whose tireless contribution alongside their Board and membership was tide-turning; and

    The NSW VAD Alliance, as well as Professors Lindy Willmott and Ben White, and the many politicians, advocates and medical professionals who spoke up when it may have been easier not to.

    What happens next?

    Our focus now turns to the campaign to restore Territory rights so the Northern Territory and the Australian Capital Territory can legislate for themselves on end-of-life choice. We cannot continue to treat Territorians like second-class citizens on this, or indeed any other, issue.

    We must be vigilant in our protection of the gains already won. You can count on us to:

    • Defend VAD laws that have already passed;
    • Champion the voices of dying people; and
    • Support Australians to make their own, informed choices.


  • 03 May 2022 1:24 PM | EOLC Admin (Administrator)

    by Fiona Cassie fcassie@nzdoctor.co.nz

    GPs who have completed the online training programme may be prepared to offer assisted dying to their own patients, due to the long relationship they have built up.

    GPs are finding it rewarding to work with patients who seek assistance in dying, Kristin Good tells reporter Fiona Cassie

    Left: Specialist GP Kristin Good, registrar of the Assisted Dying Service [Image: NZD]

    "If we didn’t wrap the support around the practitioners, this would be a very isolating sort of medicine."

    A small but growing number of GPs is training to provide assisted-dying services solely for their own patients, says Kristin Good, registrar of the Assisted Dying Service at the Ministry of Health.

    The fastest-growing group of doctors training to help people end their lives are GPs, often in response to their patients raising the topic of assisted dying, says Dr Good, a specialist GP based in Auckland.

    “The GPs are saying, ‘I will provide an assisted death for my patient with whom I’ve had this long relationship’,” she says.

    But GPs are also saying they are not prepared to offer the services to anybody but their own patients, and so are declining to be added to the Support and Consultation for End of Life in New Zealand (SCENZ) list. This list names the service’s 130 medical and nurse practitioners available to provide assisted dying.

    More than half of the 81 self-identified GPs who have completed the ministry’s online training programme are not on the list. “Some of those GPs have now been involved in more than one death.”

    Dr Good says the shift of some GPs from saying “I will never provide this service” to finding the work rewarding, has been a gratifying part of her new role, added last year to her existing portfolio as the ministry’s chief clinical advisor, health system improvement and innovation.

    Implementing the service, created by passing of the End of Life Choice Act 2019, was not an expected path for her.

    “This isn’t an act I voted for, I might add,” she says. “So, you can imagine this has been quite a journey for me.

    “And I’d be lying if I said that the polarising nature of this topic has not made for some very challenging conversations.”

    Dr Good, who works full time for the ministry from Auckland, says she is an advocate for patient choice.

    Bending over backwards

    It has been rewarding to hear of the gratitude of people accessing the service, and to get GPs’ feedback.

    “What I see in the practitioners is this very person-focused approach where they bend over backwards to be obliging.

    “The doctors who are providing this service describe it as a privilege to be involved and they also consistently describe it as hugely rewarding.”

    High-calibre practitioners are providing assisted dying, she says, praising their “complete dedication” in continuing to deliver the service despite COVID-19 stretching the workforce.

    While the “vast majority of whānau wish this wasn’t a decision their family member was making”, the GPs have respected their right to make that decision.

    One surprise for her and the team has been the number of Māori applying to the service, 12 (5.8 per cent) to date, with a number having gone on to have an assisted death.

    “We heard ahead of time that assisted dying was not consistent with tikanga Māori, but that hasn’t played out in what we’ve seen in reality.”

    She says Māori applicants have been using the assisted-dying protocol of discussing what a good death looks like to them, to create a care plan that “really makes this death their own”.

    “That has included starting with waiata and karakia and the shrouding of the person with a korowai, before they receive the medication, and other things that are meaningful for that individual.”

    Based on international trends, particularly Australia, the ministry had been concerned the number of practitioners providing assisted dying, could fall sharply after they carried out their first assisted death.

    “I was warned about that, so we have tried to wrap as much support around practitioners as we possibly [can].” Early on, Dr Good would personally phone every practitioner after they had assisted a death for the first time.

    The two, soon to be three, ministry nurses who handle all patient and practitioner queries for the service have also developed a strong relationship with the practitioners, she says. The nurses run regular question and answer sessions; the service also provides quarterly peer support groups and an annual forum, and has helped establish local networks.

    “If we didn’t wrap the support around the practitioners, this would be a very isolating sort of medicine.”

    Who’s who in the service?

    The SCENZ list started with 131 practitioners in November and, while a handful fell away due to COVID workloads, IT hitches or heading overseas, it now sits at 130; 120 medical practitioners and 10 NPs.

    Specialist GPs make up 39 per cent of the SCENZ medical practitioners, but only 37 of those 47 GPs have completed training.

    The other medical practitioners listed are oncologists, intensive care specialists, urgent care doctors, general medicine doctors and a small number of palliative care doctors.

    Just over 90 of the medical practitioners listed on SCENZ are available as attending medical practitioners to provide initial assessments and attend at assisted deaths. Some are also on the list of 83 independent medical practitioners available to provide the required second assessment.

    Eleven psychiatrists are available if the first or second assessing doctors are unable to determine the applicant’s competency to make a decision. This hasn’t been needed yet.

    Dr Good says it’s important more NPs take part.

    She says some NPs were understandably unhappy because the service allows them to help people plan a death, and to administer medication for assisted deaths, but only under the instruction of an attending medical practitioner. NPs cannot write prescriptions for assisted-dying medications – an issue being worked on by the Nursing Council.

    “Nurse practitioners have been particularly willing to travel around the country, which has been absolutely fantastic,” Dr Good says.

    A number of GPs and NPs are working together as teams, and the ministry wants to build on this, she adds.

    High demand

    Dr Good says assisted dying is not an acute service and the ministry had set an expectation that the service would take four to six weeks.

    But demand was high in the early days, with 20 per cent of the call volume coming through in the first week alone.

    That led one applicant to make a formal complaint about waiting too long for an initial referral to an attending medical practitioner.

    It’s one of the three formal complaints received; one of these complaints has gone to the health and disability commissioner.

    Dr Good says referrals in urban areas are now made within one to two days or sometimes on the day of the call. In rural and remote areas, it can take one to two weeks.

    Demand remains high, with on average the service’s nurses receiving 46 enquiries a week about assisted dying. The service also has high numbers of calls from practitioners wanting to know about training or referrals.

    One aspect of the service that needs improving is communication with the patient’s general practice when an assisted death has been approved and taken place, Dr Good says.

    “I am aware that this isn’t happening as well as it should, and we are working on that.”

    But, she says, consent is required. Some applicants don’t want their GP to be told, as they know or suspect their GP is a conscientious objector to assisted death.

    Dr Good says one interesting development is the response of palliative care services to someone applying for assisted dying.

    “We know, from overseas, that the quality of palliative care increases when assisted dying is introduced because, clearly, satisfactory or good palliative care is preferable to someone feeling they need to access assisted dying because their suffering is intolerable – when it can be relieved.”

    The trend has shown up in New Zealand. Some people receiving palliative care have applied for assisted dying because of intolerable suffering and pain and have then experienced better pain relief, so they haven’t proceeded with assisted dying.

    Dr Good says just one hospice has worked with the service, south Auckland’s Totara Hospice, which has sought to develop a strong partnership between palliative care and assisted-dying services.

    First quarterly report: 66 assisted deaths to date

    Assisted Dying Quarterly Report: 7 November 2021 to 31 March 2022

    Download 290.18 KB

    More than 200 people applied for and 66 people had an assisted death in the early months of the Assisted Dying Service.

    The Ministry of Health has published its first quarterly report on the service, covering from 7 November last year, when the End of Life Choice Act 2019 came into force, to 31 March.

    Of the initial 206 assisted-dying applications, 168 went on to have an initial assessment completed by an attending medical practitioner, and 126 to receive a second opinion from an independent medical practitioner.

    Forty applicants were assessed as being ineligible for the service for a variety of reasons, and 59 of the applications are still in progress.

    Of the 66 people who have had an assisted death to date, most (73 per cent) died at home, 17 per cent in aged-care facilities, 6 per cent in DHB facilities and 4 per cent in a hospice.

    Eleven of the 206 applicants withdrew their application. Thirty of the applicants died while their application was in process.

    Of the initial 206 applicants:

    • 79 per cent are NZ European/ Pākehā and 5.8 per cent Māori
    • 55 per cent are women
    • 74 per cent are aged 65 years or older and only 4 per cent are aged under 45
    • 65 per cent have a cancer diagnosis, followed by 10 per cent with a neurological condition
    • 80 per cent were receiving palliative care at the time of their application.
  • 17 Dec 2021 12:53 PM | EOLC Admin (Administrator)

    BY CO-EDITOR MARY LONGMORE
    Source: NZNO Journal Kai Tiaki

    A Waikato aged care nurse practitioner (NP) registered to assist eligible people to die says she feels obligated to help after years of seeing needless suffering in aged care.

    Kai Tiaki agreed not to name the NP, as she feared other nurses’ reactions.

    One man with motor neurone disease stood out in her memory. Dependent on others for all his needs, including toileting, he had a gastronomy feeding tube in place but refused to allow anyone to feed him through it.

    “Unable to swallow, in effect he starved himself until the pneumonia came and took him away,” she recalled. “This was very difficult for his family and staff, as well as the man himself. All he wanted was some dignity and choice.”

    She is now poised to assist a patient to die for the first time, since the End of Life Choice Act (EOLCA) came into effect on November 7.

    “I really don’t know how I feel – apprehensive and worried, probably.”

    She would be accompanying a GP, who knew the patient. Under the EOLCA, NPs were not able to be part of the early process including decision-making, which would likely make it difficult to form relationships with patients, she said.

    “I think the whole thing is going to be really difficult – the GP or attending practitioner can form a relationship with the patient over time, but the NP is potentially going to be coming in at the end, without any time to form a relationship.”

    In her 40 years working in aged residential care, she has seen many deaths – some of which took a long time and involved suffering. Some – those with terminal illness such as cancer – would likely have been eligible for assisted dying, but those with dementia would not. Yet people with dementia could have very challenging deaths, she said.

    Nurses, particularly those in aged care, were often more comfortable and familiar with death than doctors, she said. “During my career as a nurse, I have been the one to administer the last [pain relief] injection to those at the end of life on numerous occasions and been present at the bedside at the time of passing.”

    The assisted dying process was highly structured, with many opportunities for people to change their minds, she said.

    “For those who have made the decision to pursue assisted dying, this will not have been done lightly.”

    It was frustrating that under the current legislation, NPs were not allowed to participate fully in the process. “Will I be able to develop a relationship with the person who has received authorisation to end their life in the time between approval and date of planned death?”

    Nor were NPs able to write the prescription currently, even if they were the attending practitioner.

    “Very much a handmaiden role again – doing the hard bit, the actual procedure!”

    However, it was a start, she said.

    Nurse Practitioners New Zealand (NPNZ) chair Sandra Oster said the EOLCA required NPs to act under the instruction of an attending medical practitioner, even though they were authorised practitioners.

    The MoH had acknowledged the error but had taken the view it could be amended when the legislation was reviewed, she said. There was no set date for a review.


  • 17 Dec 2021 12:45 PM | EOLC Admin (Administrator)

    BY TAMAH CLAPHAM
    December 1, 2021
    Source:  NZNO Journal Kai Tiaki

    After seeing too many people die without whānau, Auckland NP Tamah Clapham has trained and registered to provide care under the End of Life Choice Act.

    In 20 years of nursing, I have been present at dozens of deaths.

    As an undergraduate, I worked for three years as a caregiver in a rest home, so witnessed many deaths from natural causes – often without family or whānau present

    In the hospital, where I started my registered nursing career in acute care such as emergency, I also saw people die, without family or whānau present.

    In primary care, I have seen longer deaths, from complications of chronic or terminal illness.

    All these experiences have led me to believe that there is such a thing as a good death.

    While we have palliative care options that allow for a good death, for some who are terminally ill with less than six months to live, the most important thing may be to have control over when and how that death may occur – and who will be there with them.

    Many experienced nurses are experts in death and dying.

    I accept that some nurses, nurse practitioners (NPs) and doctors may choose to not provide this service, due to conscientious objection.

    But it is important – as with last year’s decriminalisation of abortion – that patients are referred appropriately to a willing practitioner.

    In Aotearoa, many facing imminent death will not choose a death day, as it does not align with their values or belief system. I respect that choice too. The legislation is very clear that a clinician is not to raise the topic with a patient and this is a way of protecting against any coercion.

    I have completed the Ministry of Health (MoH) training. The legislation and rollout has many processes to ensure the person seeking assisted dying is competent to do so and free from coercion. This involves up to three practitioners certifying this, two medical initially and – if not satisfied – a third opinion is sought through psychiatry colleagues.

    Although this is new to us here in Aotearoa, the MoH can use experience from Australia and Canada, where similar legislation is already in place. This gives us something to base our own interpretation and practice on.

    The SCENZ (support and consultation for end of life in NZ) group includes a range of practitioners and oversees the EOLCA, along with a medical officer. There is also an 0800 number for support.

    But it is disappointing that the MoH only appointed one nurse representative – NP Jackie Robinson – to SCENZ. See You can’t know what you would decide, Kai Tiaki November 2021.

    It is top-heavy with medical practitioners, who comprise seven out of the 12. However, it does appear to have good representation for Māori.

    My understanding, from listening to a colleague in Canada, is that the service is deeply valued by the patient and the community supporting them.

    From what I have learned about the death day, I think it would best involve two clinicians to support the individual, their whānau and community, as well as the clinicians themselves. The range of skills needed would best be delivered through a collegial approach.

    The EOLCA refers to a medical practitioner. The MoH appear to have interpreted that literally, despite 2019 amendments to the Health Practitioners Competence Assurance Act to allow qualified health practitioners to carry out activities that could previously only be done by doctors.

    As things stand now, if an NP is approached by a patient about assisted dying, they must refer to a medical practitioner, who must then seek a second opinion from another medical practitioner.

    Yet I believe it is entirely within an NP’s competency to be able to provide a first or second opinion on a patient’s eligibility and competency. It does concern me that in rural areas especially, this may increase barriers to access and create inequities.

    Currently, NPs are able to administer the life-ending medication but not assess eligibility or initial consent. I find this very strange decision-making and wonder about the hegemony of the MoH decision-makers in their interpretation.

    An NP/GP model, and an RN-led assisted dying service in rural areas, would be much more representative of the workforce available. It would ensure a quality and equitable service, as well as shoring up the wellbeing of practitioners.


  • 26 Nov 2021 10:36 AM | EOLC Admin (Administrator)

    Source: NZ Doctor

    Zahra Shahtahmasebi introduces the specialist GP who will have oversight of every assisted death in New Zealand

    Specialist GP Kristin Good, registrar of the new assisted-dying service [Supplied]

    Criteria, End of Life Choice Act 2019

    The act contains six criteria, all of which must be met. The person must:

    • be aged 18 years or over
    • be a citizen or permanent resident of New Zealand
    • suffer from a terminal illness that is likely to end their life within six months
    • be in an advanced state of irreversible decline in physical capability
    • experience unbearable suffering that cannot be relieved in a manner the person considers tolerable, and
    • be competent to make an informed decision about assisted dying.

    New Zealanders who were waiting for the End of Life Choice Act 2019 to come into force have already got their applications in to the new assisted-dying service.

    The Ministry of Health has received two formal applications currently, with a number “still in the process”, says group manager, quality assurance and safety Emma Prestidge.

    Newly appointed registrar, specialist GP Kristin Good is expecting only half will meet the criteria and, of those eligible, only a small proportion will go on to access assisted dying.

    This is because for some, having the choice in their back pocket is all they need, she says. “It gives them greater control, after feeling disempowered. Having the choice means they don’t necessarily need to go through with it.”

    Dr Good is the ministry’s chief clinical advisor, health system improvement and innovation, and took up her additional role as registrar on 7 November.

    She says applications will take four to six weeks for the person’s eligibility to be determined. This also includes the time to match the person with a practitioner, and conduct assessments.

    “From the moment they apply, it feels very urgent to them, they want a fast process, but for us, quality is paramount.”

    Once eligibility has been confirmed, the patient can choose an appointment date for the lethal medication to be administered within six months. They can bring it forward at any point, or extend it by another six months.

    So far, the total number of practitioners who have given an expression of interest to join the Support and Consultation for End of Life in New Zealand (SCENZ) Group’s list of providers is 131. The group is the statutory body for the assisted-dying service, responsible for maintaining the list of providers and providing contact details of practitioners.

    The list is mostly GPs, palliative care physicians and oncologists, with the remainder made up of 13 psychiatrists, and 10 nurse practitioners. Ms Prestidge says 95 have indicated they will be interested in being an assisting medical practitioner, 91 an independent medical practitioner. She adds that as all doctors can potentially do multiple roles, even the psychiatrists, this explains the overlap seen across the two categories.

    One-third of them are located in the South Island and two-thirds in the North, and 70 per cent have indicated they are able to travel. This is essential, as the ministry is not expecting providers will be located in every area, says Dr Good.

    A number of GPs have indicated interest, not in being on the SCENZ list, but in providing assisted dying for their own patients. Although these GPs do not have to register, doing so allows the group to work hand in hand with the practitioner and provide support.

    Health professionals have registered with SCENZ in larger numbers than she expected. She is aware assisted dying is a polarising topic, and many health professionals would have voted against it in the 2020 referendum.

    But, as the legislation has started to be implemented in the past year, some have begun to change their minds.

    Dr Good is also surprised by the speed at which health professionals have taken up the training. “If you compare the numbers, we have 131 whereas Western Australia has eight.”

    At one end of the spectrum are people interested in providing the service, possibly due to their own experiences with patients or family members, and at the other end are those who will never consider it, says Dr Good.

    In the middle are those who are not conscientious objectors, but who don’t see assisted dying within their scope of practice. For these practitioners, the long-term patients may change their minds, she adds.

    “When they come to you and say ‘will you do this for me’, some are starting to see assisted dying as the next step in their continuity of care – they hadn’t considered it until now.”

    Dr Good was formerly clinical director COVID response at national telehealth service Whakarongorau Aotearoa, joining the ministry in February. As registrar, she has oversight of every assisted-dying case to ensure that every single requirement under the legislation has been met, before the doctor gets the medication.

    She will also be involved with reporting and managing complaints, working closely with the Office of the Health and Disability Commissioner, the medical and nursing councils of New Zealand, and police if required. Death reports will be filed by the health professional within 14 days of the death. The registrar is based within a secretariat, mostly staffed by senior nurses who support service provision and provide advice.


  • 09 Nov 2021 1:30 PM | EOLC Admin (Administrator)

    Ministry of Health
    Media release

    08 November 2021

    The Ministry of Health says ensuring a robust process for those seeking assisted dying is an essential safeguard as part of the new service.

    The assisted dying service has been formed as part of the implementation of the End of Life Choice Act 2019. It is a new health service in New Zealand, available to some people with a terminal illness who are nearing the end of their lives.

    The Ministry has worked closely with a wide range of health and disability sector representatives to ensure the service is safe and accessible to those who request this option.

    The Ministry will have oversight of the service. Clinical advisors are part of the secretariat to ensure appropriate information and support is on offer to help the person and their whānau navigate the steps in the assisted dying services, and provide follow up pastoral support following an assisted death.

    Dr Kristin Good has been appointed the Registrar (assisted dying).

    ‘The health sector has been thoughtful and engaged as we worked together over the past 12 months to form an assisted dying service. As well as meeting the legislative requirements, the implementation has focused on ensuring there is a workforce trained and ready to care for people with a terminal illness who may seek this service, and there are important safeguards in place,’ says Dr Good.

    ‘We want to thank the health sector for their support and consultation over the past 12 months and we also want to thank health practitioners for continuing to support the new service.’

    Dr Good says as part of the initial establishment she will be making herself available to medical and nurse practitioners and psychiatrists to support navigating the new service.

    ‘Assisted dying will now be available as an option for people experiencing unbearable suffering from a terminal illness that is likely to end their life within six months. It’s important to reiterate that assisted dying is not a replacement for palliative care or health care services. It provides another option for people with a terminal illness in certain circumstances.

    ‘There are strict eligibility criteria. Not everyone with a terminal illness will be eligible.’

    A person seeking assisted dying needs to raise it with their doctor or health care team. A health professional cannot raise assisted dying with a person.

    ‘We’re uncertain what demand for the new service will be like in New Zealand but we’re aware assisted dying typically accounts for between 0.3 and 2% of all deaths in other jurisdictions.

    ‘Not all doctors will provide assisted dying services, but they will be able to tell a person who raises it where to find the information they need. There is information about the service, including public resources, and contact details, on the Ministry’s website,’ Dr Good said.

    Assisted dying is a sensitive topic and may be difficult for some people. If reading this information has raised some distressing feelings for you, please know there is support available. You can call or text 1737 for free to speak to a trained counsellor at any time.

    Background

    Assisted dying services will be delivered by medical and nurse practitioners, working with a dedicated secretariat at the Ministry of Health, along with advice and support from the Support and Consultation for End of Life in New Zealand (SCENZ) Group. The SCENZ Group maintains the lists or practitioners who will provide parts of the service, such as assessments.

    Assisted dying services are most likely to be provided in a person’s home or other community settings, rather than in hospital settings. The Assisted Dying Service secretariat provides a consistent point of contact and oversight of the service. This includes a consistent point of contact for the person, their whānau, and involved health practitioners.

    The Registrar (assisted dying) is part of the secretariat. Their role checks that the processes required by the Act have been complied with to ensure people who wish to receive assisted dying are eligible and notifying the person’s doctor, known as the attending medical practitioner, if they are satisfied that the processes have been complied with before the administration of assisted dying medication.

    The secretariat also includes clinical advisors who provide information and support to help the person and their whânau navigate the steps in the assisted dying services, and provide follow up pastoral support following an assisted death.

    The secretariat will work with the Support and Consultation for End of Life in New Zealand (SCENZ) Group to identify practitioners from the SCENZ lists to undertake the assessment processes.

    Assisted dying will become part of the existing health and disability system and there will be continuous improvement activities over time, and ongoing engagement with the health sector as this new health service establishes.


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Better Off Dead

 – Andrew Denton

Season 2

Andrew Denton investigates the stories behind Victoria’s landmark Voluntary Assisted Dying (VAD) law: Who seeks to use it, and why? Who are the doctors stepping forward to help them? And how does the Church continue to resist a law it describes as ‘evil’? 

Listen to Season 1 »

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