Reuters

Rafael Botella, 35, tetraplegic since he was 19 after a car crash where his girlfriend died, works on the computer at his home in Simat de la Valldigna, Spain, February 16, 2021. REUTERS/Susana Vera/File Photo

MADRID, March 22 (Reuters) - Spain's Constitutional Court has dismissed a challenge by far-right party Vox against a euthanasia law approved in 2021, dealing a second blow to Vox on Wednesday as its no-confidence motion against the government failed in parliament.

By a wide margin of nine votes in favour and two against, the court's justices upheld the bill that legalised euthanasia and assisted suicide for people with incurable or debilitating diseases who want to end their life.

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Spain is the fourth country in the European Union to have such a law.

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The ruling came right after Vox's attempt to oust Prime Minister Pedro Sanchez with a no-confidence vote failed to garner the 176 votes it needed to succeed, obtaining just the backing of Vox's 52 lawmakers and one independent deputy.

The court said it based its ruling on two constitutional articles guaranteeing the fundamental right to physical and moral integrity and the principles of human dignity and free development of personality, respectively.

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"The Constitution protects a right of self-determination that allows individuals to make a free, informed and conscious decision on how and when to die in medically proven situations of terminal or seriously incapacitating illness," Judge Ramon Saez wrote.

Both Vox and the conservative People's Party (PP) had voted against the bill. Euthanasia is strongly opposed by the Catholic Church, whose doctrine views life as a divine gift that should not be prematurely shortened.

The PP also challenged the constitutionality of part of the law before the top court, but Wednesday's ruling effectively means it is set to be dismissed with the same arguments the court used to throw out Vox's appeal.

 

Assisted Dying Service - March 2023 Update

In this edition:

• Assisted Dying – Mate Whakaahuru Forum: One Year of Service 2022

• Yearly Reporting Update

• Function Transfer

 

Assisted Dying – Mate Whakaahuru Forum: One Year of Service 2022

Manatū Haoura (Ministry of Health) successfully hosted a workforce forum on 26 and 27 November 2022 in Wellington to mark the first year of the Assisted Dying Service.

The forum provided an opportunity for people from the health and disability sector to come together to share their experiences of the assisted dying service and look ahead to the ongoing development of the service. The setting provided a safe space for practitioners to have open discussions, network with their peers and meet the Assisted Dying Secretariat kanohi ki te kanohi. It also provided attendees with an opportunity to give feedback on the service to date.

The forum included presentations, panel discussions and practical breakout sessions presented by both Manatū Hauora and guest speakers. These included the Human Rights Commission, Te Apārangi: Māori Partnership Alliance, assisted dying service providers and practitioners from other end of life care services such as palliative care. The post event survey feedback was very positive and supportive of the event.

 

Yearly Reporting Update

The Ministry is preparing its first annual yearly assisted dying service report.  The Ministry is aiming to publish the report by the end of March 2023 on their website.

 

Functions Transfer

Aotearoa New Zealand’s health and disability system is being transformed to create a more equitable system and achieve better health and wellbeing outcomes for all New Zealanders. 

What does this mean? 

As part of these reforms, some functions have been transferred from Manatū Hauora to Te Whatu Ora, particularly those with an operational focus. 

Some clinical advisory and operational functions from the Regulatory Assurance Functions (Assisted Dying and Abortion Services) transferred to Te Whatu Ora on 6 March 2023.  

This transfer will not impact service delivery, and key contacts will remain the same.  

Functions will be shared across the two organisations in line with the broader health transformation to improve service delivery for all who reside in New Zealand. 

Over the coming months, websites will start to look a little different. You may be redirected to a new look website managed by either Te Whatu Ora | Health New Zealand or Manatū Hauora (Ministry of Health). 

Source: ODT

Opinion

PHOTO: GETTY IMAGES

The upcoming review of the End of Life Choice Act is an opportunity to reconsider advance directives for dementia, Dr Mac Gardner writes.

It is now more than a year since assisted dying became legal, and the End of Life Choice Act has allowed physician-assisted dying according to certain criteria.

These criteria restrict this choice to those who (a) are of sound mind, and whose choice is therefore fully informed, and (b) have less than six months of predicted survival.

Thus, of the 214 people accessing the service up to September last year, the considerable majority suffered from advanced cancer, and a smaller number were diagnosed with the muscle-wasting condition, motor neuron disease.

One group who are, by these criteria, excluded from the choice of an assisted death are those in an advanced state of dementia, the commonest being Alzheimer’s disease.

But they cannot, on current criteria, make the cut. Obviously enough, a demented person would not, at the time, "be competent to make an informed decision about dying" — and survival can extend unpredictably well beyond six months.

Back in 2012, in an earlier iteration of Parliament gearing itself up for a debate apropos, Maryan Street drew attention to public demand, saying "The thing I clearly had in my mind, and from what I’ve been told time and time again, is that prominent fear of Alzheimer’s, people’s fear of ending their days with a lack of dignity, and not even knowing. So I had to put it in [the planned legislation]".

But her Bill died aborning; and when David Seymour reignited the question some years on, whether or not he might have preferred to include dementia as a grounds, he needed to compromise in order to bring others in Parliament on side.

The difference with respect to dementia is the need for an advance directive, to be written when the person is of sound mind — and this is not allowed under the current law.

We can look to jurisdictions overseas for precedents where people can write an advance directive in the specific case of a subsequent dementia.

It was most recently proposed in Quebec and Canadians are broadly in favour.

In a recent survey for The Globe and Mail (Toronto’s morning paper), "80% of respondents agreed, or somewhat agreed, that Canadians should be able to make advance requests outlining their conditions for assisted death, for when they can no longer legally give consent".

New Zealanders might be fairly similar in their views.

The broad principle is straightforward, and the End of Life Choice Society of New Zealand has free downloadable Advance Directives on their website.

How might our law respond to this? On the specific question of dementia, I have proposed that the following paragraph be inserted in the present legislation, allowing access to physician-assisted dying, for a person who "has made, while in full possession of the person’s mental faculties, and being above the age of 65 years, an advance directive that assisted dying should be administered in the event that the person would, in the future, have entered into an advanced state (stage five or above of the Alzheimer scale) of irreversible dementia, notwithstanding a mental inability at that time to revisit or to confirm the decision, and notwithstanding a likelihood that survival otherwise could extend beyond six months".

By stage five, memory loss is severe, agitation and confusion is common, and the person requires assistance with daily living; and they would no longer be competent to give informed consent.

Stage six is worse; stage seven is nearing a natural death.

The current Act was introduced to enable people who "experience unbearable suffering that cannot be relieved in a manner that the person considers tolerable" to cease their pain and end their lives. Quoting Shakespeare (who well understood humanity), "Though death be poor, it ends a mortal woe".

It is true that advanced dementia does not bring with it physical pain.

But we may here consider the anticipatory existential suffering that would be one’s fate — the thought that one might end up in a nursing home unaware of surroundings, not recognising family, doubly incontinent, daily dressed and undressed by a kind attendant, shunted unknowing from bed to chair and back to bed, and becoming little more than a human husk, the essential spark of humanity all but extinguished.

There’s a cliche that can describe this, at least as many would see it: a fate worse than death.

My proposal as above is, I understand, to be included among the material to be considered for when the Act comes up for review.

It will not go amiss if those who find themselves in agreement raise their voices in support.

— Mac Gardner is a retired medical geneticist.

The Voluntary Assisted Dying Act will take effect from Tuesday 31 January 2023, allowing people who are terminally ill and suffering intolerably to ask their doctor for medical assistance to hasten their death.

If you want to access voluntary assisted dying (VAD), your first port of call is the VAD Care Navigator Service in SA. Phone them to speak to a Care Coordinator, trained to provide information about VAD. They can support you through the application process, which can be complicated. They also provide support for regional, remote and rural areas.

The SA government has also released this helpful booklet.

Go Gentle's CEO Dr Linda Swan welcomed the new law:

We are pleased South Australia has become the fifth state to allow voluntary assisted dying for its citizens suffering with terminal illness. This is a much-needed choice that will bring relief, comfort and reassurance to people at the end of life.

Who can apply for VAD?
To use South Australia's law, a person must be:

• Diagnosed with an incurable disease, illness or medical condition that is advanced, progressive and will cause death within 6 months (or 12 months if you have a neurodegenerative condition)
• Mentally competent to make decisions about VAD
• Acting freely and without coercion
• Aged 18+
• Able to meet residency requirements
• Approved by two doctors and have made three separate requests for VAD

To find out more, visit the SA Health VAD page.

Why have we had to wait?
The law passed the South Australian Parliament in June 2021. However, there has been an 'implementation period' before the law takes effect so medical staff could be trained and systems set up.

What happens now?
If you or someone you love has been diagnosed with a terminal illness and are considering VAD, it is important to speak to your doctor about your wishes and contact the VAD Care Navigator Service if you need support.

Remember - to avoid stress and delays, start the process early. VAD is not an emergency procedure. Experience from other states shows it can take several weeks, on average, to complete the application.

Finally, thank you!
This law would never have passed without the impressive community advocacy from individuals, families and doctors who fought for this reform.

Our deepest gratitude also goes to the members of the SA Parliament who took such care to place decisions back in the hands of dying people.

Last but not least, thank you to each and every one of you who took the time to write to your MPs, bravely share your stories, sign petitions and attend vigils up and down SA. It made all the difference.

If you have any questions, please do get in touch.

The team at Go Gentle Australia

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.

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)

Click here to read more »

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

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.

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: