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.