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.

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:

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.

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.

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.

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.

Assisted dying in New Zealand became a legal choice from this coming Sunday, just as our health system is being increasingly overwhelmed by COVID.

End-of-Life Choice Society President, Dr Mary Panko, is worried that terminally ill patients who want to end their suffering may now hesitate to ask their doctor for help for fear of adding to the medical burden.

Dr Panko recognises it’s an awkward time for the new legislation to come into force, but she says “Anyone who fits the criteria of being terminally ill, diagnosed to die within six months, and suffering unbearably, please don’t be put off. Be brave, ask for assistance and if you are not getting it, come to us. We are here to help. The End-of-Life Choice Society continues to provide public education and information on its website at www.eolc.org.nz.”

“We highlight the eligibility criteria, how to express a request for assisted dying and what to do if your doctor turns out to be a conscientious objector.”

Dr Panko says “the new law brings enormous peace of mind for those whose dying would otherwise be protracted, terrifying, agonising or dehumanising. They can now ask a doctor to help them die earlier thus avoiding days, weeks or perhaps months of unbearable suffering.”

Aotearoa New Zealand has around 35,000 deaths each year. Of these, it is expected only 1% or 2% will meet the eligibility criteria for assisted dying. “Our eligibility criteria are very strict, much stricter than in, say, Belgium, the Netherlands or Canada. We have strong safeguards and protocols to ensure scrutiny and oversight both before and after the assisted death.”

“As it happens, today, 2 November is World Right-to-Die Day – celebrated each year by the World Federation of Right-to-Die Societies. Around 250 million people worldwide are now covered by assisted dying laws and that number is growing. People will no longer be fobbed off with false promises that palliative care can relieve suffering for everyone if only enough money is put towards it. Data-driven and anecdotal evidence from around the world show that it simply cannot.”

“We thank our politicians for changing the law, New Zealanders for voting to endorse the legislation at the 2019 referendum, and most importantly we thank our medical workforce for their compassion and willingness to help those of us who would otherwise face a tortured end.”

Contact Details:

• Ministry of Health helpline for people whose own doctor declines to participate in assisted dying is 0800 223 852. Their email address is: AssistedDying@health.govt.nz
• EOLC Society President, Dr Mary Panko 027 419 7802 or info@eolc.org.nz Website: www.eolc.org.nz

Hon Andrew Little –-Minister of Health

12 October 2021

PĀNUI PĀPĀHO – MEDIA STATEMENT

Health system is ready for assisted-dying law

The health system is ready for the implementation of the End of Life Choice Act when it takes effect next month, making assisted dying legal in New Zealand, Health Minister Andrew Little said today.

The law received 65.1 per cent support in a public referendum held alongside last year’s general election, and is due to come into force on November 7.

Andrew Little says the Government has appointed a three-person specialist committee to oversee the operation of the Act. Membership of the End of Life Review Committee must include a medical ethicist, a doctor specialising in end-of-life care and a health practitioner.

The first three members of the committee are:

- Dr Dana Wensley, medical ethicist.

- Ms Belinda Close, health practitioner.

- Dr Jane Greville, medical practitioner practising end-of-life care.

“The committee will review reports on assisted deaths and report to the Registrar (assisted dying) at the Ministry of Health and to the Minister of Health,” Andrew Little said.

“This independent review mechanism is one of the many safeguards put in place to ensure the service is operating in line with strict criteria set out by the Act.

“The other body required under the legislation, the Support and Consultation for End of Life in New Zealand group, or SCENZ, was appointed in August. Its responsibilities include maintaining a list of health practitioners providing assisted-dying services, and helping develop and oversee standards of care.”

Andrew Little said the Government had also put in place funding, through the Ministry of Health.

“The Government is committed to ensuring health services are available equally to everyone who needs them, and this includes assisted-dying services,” Andrew Little said.

“We expect that in most circumstances, these services will be provided in the community and will be free for people who meet the strict eligibility criteria.

“Medical and nurse practitioners who provide care as part of the assisted-dying service will be paid for their work and for their travel costs.”

For further information contact Adelia Hallett 021 802 905

Biographical details for members of the first End of Life Review Committee

Dr Dana Wensley is a barrister and solicitor of the High Court of New Zealand and Commissioner for Resource Management Act hearings. She has previously worked as a registered nurse, solicitor and a senior research fellow. Since 2015, she has been a lawyer-member of the National Ethics Advisory Committee and a community representative on the Hospital Advisory Committee at Nelson Marlborough District Health Board. She is also the current chair of the Tasman District Council’s Regulatory Committee and for the Accessibility for All Forum. She received her doctorate in Medical Law and Ethics from King’s College in London in 2006.

Belinda Close has been the director of nursing at Ashburton Rural Health Services since 2018 and is co-chair Māori of both the Nurses Executive New Zealand and the National Nurse Leaders Group. She has 31 years’ experience managing and handling sophisticated health needs of people in hospitals and communities across Aotearoa and Australia, with a focus on indigenous health, clinical supervision and corporate and clinical governance.

Dr Jane Greville is a palliative care consultant at Harbour Hospice in Auckland and previously worked as the Medical Officer at North Shore Hospice. She is a representative on the executive of the Aotearoa branch of the Australia and New Zealand Society of Palliative Medicine, and previously served as a member of the Board of Dove Hospice. She has more than 30 years’ experience working in health care, primarily in general practice, and has worked specifically in palliative care since 2013.

More information on the implementation of the Act and the End of Life Review Committee can be found at https://www.health.govt.nz/our-work/regulation-health-and-disability-system/end-life-choice-act-implementation/end-life-choice-act-statutory-bodies-and-governance

Source: Go Gentle Australia

Opportunity: Participate in academic research

With Victoria's voluntary assisted dying scheme operational for more than two years, now is an opportune time for researchers to examine the system and see how it can be improved.

We are sharing with you two opportunities to participate in academic research about VAD in Victoria. You will contribute to research that will shape and improve VAD laws in Australia and around the globe.

1 Help Professor Ben White, QUT & his international team with their leading research

Ben is one of the leading end-of-life researchers in Australia and helped shape Queensland's recent VAD law along with his research partner Professor Lindy Willmott. This project will explore the regulation of voluntary assisted dying (VAD) as a new and important aspect of end-of-life decision-making and propose a new optimal regulatory framework for VAD in Australia. Read more

• Have you been involved in decision-making about accessing voluntary assisted dying (VAD) in Victoria or supported a loved one through this process?

• Are you an adult with a diagnosis of terminal illness or the family member of an adult with terminal illness?

If you answered yes to both of these questions, please contact Professor Ben White on 07 3138 4066 or email bp.white@qut.edu.au

You will need to be available for a private interview (up to 1hr) either in-person or by telephone/Zoom.

2 Participate in a study led by Monash University about VAD in Victoria

Researchers from a number of universities, led by Monash University, are involved in a four year project to evaluate the impact and consequences of the Victorian VAD law.

The Monash team want to speak to people diagnosed with a terminal illness, people who are contemplating choosing VAD and bereaved family or carers of people who have been through the VAD process.

To find out more contact the VAD Research Project on 03 9903 8286 or email vad.research@monash.edu

Participation will involve completing a questionnaire and taking part in a short interview and/or a focus group. The team may ask to follow up with you periodically.

Thank you for your ongoing support,

The Team at Go Gentle Australia

Source: Go Gentle Australia

Exciting news. Queensland has become the fifth Australian state to legalise voluntary assisted dying - and the third this year!

Parliament voted this evening to pass the Voluntary Assisted Dying Bill 2021 into law without amendment, 61 votes to 30.

The law now heads to the Governor for royal assent. It will come into effect in Jan 2023.

We applaud everyone who made this moment possible

- Premier Annastacia Palaszczuk, her deputy Steven Miles and parliamentary staff for their leadership and stewardship of the Bill. 

- Parliamentary Health Committee chair Aaron Harper and fellow members for their tireless work and compassion. 

- Independent MP Sandy Bolton and the Greens for their longstanding crossbench advocacy.

- All MPs who voted Yes for the rights of the terminally ill. 

Most importantly, we pay tribute to the community advocates who campaigned for this law, sometimes over decades. 

- Indefatigable local campaigners Tanya Battel and her Gang of Four (Bev Young, Lyn Bailey, Therese McLean), Fiona Jacobs and her group Nurses Supporting VAD, Jann Stuckey, Dr Will Cairns, Dr Gracelyn Smallwood, Marj Lawrence, Moya Jackson, Phil Browne, John Ancliffe, Kaela Gray, Susan Reilly, Everald Compton and Penny Tovey.

- Dying with Dignity Queensland, led by Jos Hall, Jeannette Wiley and Jen Blake, which, together with Doctors for Assisted Dying Choice and the Clem Jones Group, formed the My Life My Choice alliance.

-The QLD4VAD alliance, showcasing a broad coalition of support from unions, doctors, nurses, first responders, lawyers and other groups.  

- Queensland’s union movement, which was central to the success of the campaign. Special thanks to Stu Traill of the ETU, who took on the VAD cause in memory of Peter 'Simmo' Simpson, former ETU secretary and VAD advocate, who died from melanoma last year.

- Professors Ben White and Lindy Willmott from the Australian Centre for Health Law Research for their expert forensic advice and advocacy.

And every supporter and advocate, past and present, who bravely shared their stories, contacted MPs, donated funds and volunteered their precious time.

This historic moment particularly honours those who are no longer with us, but whose courageous advocacy was instrumental in changing MPs’ hearts and minds.

A win for compassion and evidence

We congratulate everyone for the respect shown on all sides of the debate and the reliance on evidence to formulate public policy.

Go Gentle Australia's time spent speaking with MPs, our leadership of the QLD4VAD Alliance, a dedicated advertising and social media campaign and our evidence-based resources, including the Better Off Dead podcast, were central to the success.

17 million Australians now live in a state with VAD laws

But we won't rest until all of us have access to compassionate and humane choice at the end of life.

A VAD bill is soon to be tabled in the NSW parliament and a bill is before the Australian parliament to give back to the Northern Territory the right to pass VAD laws.