Written by Catherine Smith, ANZ-LCNF New Zealand Representative
CNS Lung Cancer, Christchurch Hospital
Note: The information contained in this article has been collated from the Ministry of Health Assisted Dying website.
Assisted dying, also known as euthanasia or medical assistance in dying, was legalized in New Zealand on 7 November 2021, with the End of Life Choice Act coming into effect. The End of Life Choice Act was passed by the New Zealand Parliament in November 2019. The Assisted Dying Service allows a person with a terminal illness to request medication to end their life.
To be eligible for assisted dying, a person must meet all the following criteria:
- 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
- Be experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable.
- Be able to make an informed decision about assisted dying and give informed consent.
A person can’t access assisted dying solely because they have a mental disorder or mental illness, have a disability or are of advanced age. Furthermore, the person must have the capacity to make decisions about their own health and must request assisted dying themselves. They cannot be coerced or influenced by others to make this decision.
Advance directives or Advanced Care Plans cannot be used for assisted dying in New Zealand. An advance directive is a statement setting out what treatment the person wants, or does not want, to receive in the future.
The person must be the one to raise assisted dying with someone in their health care team. A health professional cannot suggest it as an option.
The Assisted Dying Service can coexist with palliative care, it doesn’t replace existing end of life care options. It provides another option, for an individual with a terminal illness if they meet the strict criteria outlined above.
The process for accessing assisted dying is set out in the Act. The steps involved include:
- a doctor assessing whether the person is eligible
- a second, independent doctor assessing whether the person is eligible
- if required, a psychiatrist assessing whether the person is competent to make an informed decision
- planning for the assisted death, including choosing a date and time and the method for the administering the medication
- a doctor or a nurse practitioner (under the instruction of a doctor) administering the medication.
There is no set time frame for this process, however it can take 4 – 6 weeks to confirm a person’s eligibility for assisted dying from when the request is made.
7 November 2021 – 30 September 2022 Overview
The New Zealand Ministry of Health provides data on Assisted dying applications and assisted deaths. Figure One gives an overview of the pathway from initial application to an assisted death. Between 7 November 2021 and 30 September 2022, there were 596 applications made for assisted dying. As of 30 September:
- 294 applications were eligibility confirmed. 214 people1 of the 294 applications had an assisted death, and the remainders are those who:
- withdrew their application; or
- died of their underlying conditions before their scheduled assisted death; or
- were waiting for their scheduled assisted death
- 120 applications had been assessed as ineligible for assisted dying
- 68 applications are still in the assessment phase
- 259 applications did not continue the process (due to being ineligible, withdrawing or dying of underlying conditions)
As at 30 September 2022:
- 78.8% of applicants are NZ European/Pākehā
- 4.8% of applicants are Māori
- 56.9% are women
- 74.8% are aged 65 years or older
- 65.6% have a cancer diagnosis
- 77.9% were receiving palliative care at the time of application.
As at 30 September 2022, 214 people had an assisted death. Assisted deaths can take place at the person’s home or in the community. The breakdown by location is:
- 174 (or 81.3%) at the person’s home or another private residence
- 17 (or 7.9%) in aged care facility
- 14 (or 6.5%) in public hospital1
- 9 (or 4.2%) in a hospice facility.
1 October 2022 – 31 December 2022 Overview
Between 1 October 2022 and 31 December 2022, 218 new applications for assisted dying were received. Attending medical practitioners (AMPs) completed 222 assessments, independent medical practitioners (IMPs) completed 156 assessments. During this quarter, 140 applications were confirmed as eligible and 102 assisted deaths occurred. During this period, 95 applications did not proceed due to the applicant either withdrawing their application; being found ineligible; or dying as a result of underlying conditions.
Of the 218 new applications received during this quarter:
- 82.1% were NZ European/Pākehā
- 6.9% were Māori
- 45.0% were Female/Wāhine
- 79.4% were aged 65 years or older
- 73.9% were receiving palliative care at the time of the application
- 69.7% had a diagnosis of cancer.
Between 1 October 2022 and 31 December 2022, 102 people had an assisted death. The summary by location is:
- 86 (or 84.3%) at the person’s home or another private residence
- 9 (or 8.8%) in a public hospital
- 4 (or 3.9%) in an aged care facility
- 3 (or 2.9%) in a hospice facility.
The assisted dying service is relatively new, and numbers are small. It is expected that the percentage breakdowns will change over time, both of assisted dying applicate demographics and assisted dying location.
Further information on the opinions of New Zealanders prior to the Assisted Dying referendum can be found at:
Frey, R., & Balmer, D. (2022). The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019. Journal of Religion and Health, 61(2), 1605-1620. Published online 2021 Aug 5. doi: 10.1007/s10943-021-01359-7
The patient voice is a powerful source of increasing our nursing knowledge. Ester’s story provides a patient’s insight regarding assisted dying.
The Nursing Council of New Zealand has provided information sheets and training on assisted dying. There is also an online learning module. This may only be available to New Zealand readers here.
The End of Life Choice Act 2019: Overview (learnonline.health.nz) module will help health professionals develop a working knowledge of their roles and responsibilities under the Act, including conscientious objection.