Source: NZ Doctor } Rata Aotearoa

Terminal illness likely to end life within six months is one of the criteria – but all must be met for a person’s assisted death to proceed

At least 99 health professionals want to learn the practical details of helping people to die once it becomes legal in New Zealand from 7 November.

It’s understood approximately 30 people are expected to request assisted dying in the first week of the regime made possible by the End of Life Choice Act 2019.

The 99 practitioners indicating they may play a part, are those who have signed up for two days of training at a Ministry of Health forum later this month. Only those intending to provide assisted dying can attend day two and learn the practicalities.

A further 94 health professionals have registered for the broad-brush introduction on day one, said the ministry in late August.

The workforce forum, on 29 and 30 September in Wellington (COVID-19 permitting, with online options as backup) requires three or four hours’ preparation via online learning.

A statement, provided to New Zealand Doctor Rata Aotearoa by senior media advisor Blair Cunningham, says 2022 individuals and groups have completed the assisted-dying training module at LearnOnline. A total of 2503 have enrolled.

Doctors and nurse practitioners are the clinicians who can provide assisted dying services once the act comes into force. Those who choose to, will be required to complete a set of online learning modules, says the ministry.

Amid sector doubts about the number of willing medical practitioners, the ministry also last month gave an update on its latest survey of health professionals. However, they were not this time asked whether they anticipated providing assisted dying.

In February, a similar survey prompted 30 per cent of the 1980 respondents to say they would or might provide the service to eligible patients.

The second survey, in July, drew 859 responses. Half of these were interested in further education and training. Twenty-three per cent had done online training and 35 per cent said they had a good understanding of health professionals’ obligations.

More resources and training are in preparation, for example, about the assisted-dying pathway, conversations about assisted dying, policies and procedures, and educating non-clinical and/or non-regulated workers.

Roles in assisting New Zealanders to die include:

• •attending medical practitioner – responds to their patient’s request for help to die, discusses it with them, undertakes where applicable a first assessment of whether they meet the criteria; supports them to make an application; once the assisted death has approval, can help the patient and their whānau plan the death; can attend and either administer the medicine or supervise the patient self-administering it
• •replacement attending medical practitioner – to be called on if the practitioner approached by the patient is not willing to take part/conscientiously objects
• •independent medical practitioner – a doctor who undertakes a second, independent assessment
• •psychiatrist – a clinician who advises in cases where the first and second assessments differ on whether the patient is competent to decide they wish to be helped to die
• •nurse practitioner – helps the patient and their whānau plan the assisted death, attends and either administers the medicine or supervises the patient self-administering it
• •registrar (assisted dying) – ministry-employed executive who preapproves a death, checking the person is eligible.

The ministry statement says it expects health organisations to consider their role and plan for it. The implementation team “continues to prioritise wide engagement with health service providers”, including DHBs and PHOs.

Most assisted deaths are expected to be carried out in people’s homes, with the practitioner paid by the ministry under Section 88 of the New Zealand Public Health and Disability Act 2000. No word is yet available on the fee. The service is free to patients.

A Cabinet paper indicates that travel-time payments are intended for practitioners assisting a patient who lives some distance away.

Assisted dying within DHBs is to be funded from existing DHB budgets, the paper says.

Ministry of Health End of Life Choice Act implementation web pages: https://tinyurl.com/MoHassistD and Health Navigator New Zealand describes the process from the patient’s point of view at: https://tinyurl.com/NavigAssistD

Who can be helped to die?

To be eligible under the End of Life Choice Act 2019, a person must:

• be aged 18 years or over
• be a citizen or permanent resident of New Zealand
• be diagnosed with 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
• be competent to make an informed decision about assisted dying.