Assisted dying: what you need to know about the new law

Sixty-five percent of voters in the 2019 referendum said “yes” to passing the End of Life Choice Act.

Here’s what you need to know about the act.

Who does it cover?

To request assisted dying you need to:

• be 18 years or over

• be a New Zealand citizen or permanent resident

• have an illness that’s likely to end your life within six months

• be in an advanced state of irreversible decline in physical health

• have unbearable suffering that can’t be relieved in a way you find tolerable

• be able to make an informed decision about assisted dying.

You can’t be considered if you have a mental disorder or illness – including dementia – or are elderly but otherwise in good health.

People with a disability are also excluded, unless they meet the six criteria above.

You can’t choose assisted dying in advance (for example, if you’re in the early stages of mental decline) and no one can choose assisted dying on your behalf. This includes anyone who holds your enduring power of attorney (see “What if you can’t make decisions”).

How do I request assisted dying?

Ask your doctor. The request must come from you – your doctor can’t initiate a discussion, nor suggest it as an option.

Can my doctor refuse?

Yes, a doctor can refuse your request on conscientious grounds. If so, they’ll put you in touch with the Support and Consultation for End of Life in New Zealand (SCENZ) group.

This group is responsible for maintaining a list of doctors who are willing to carry out assisted dying. SCENZ also sets standards of care and provide medical and legal advice to physicians.

How much does it cost?

Doctors and nurses will be paid by the government for performing the procedure.

“The government is committed to ensuring health services are available equally to everyone who needs them, and this includes assisted-dying services,” Minister of Health 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.”

However, you’ll likely be charged for the initial appointment where you talk to your doctor about assisted dying.

I’ve made a request. What now?

Your doctor will inform you about the prognosis of your illness and discuss your decision.

They can do this in person, by email or phone.

Your doctor will also tell you about palliative care options and that you can change your mind about assisted dying at any time.

While they will encourage you to speak to your family and friends, or a counsellor, they must also let you know you don’t have to do this.

The doctor needs to be satisfied that you’re making your own decision and aren’t being pressured. This means they may talk to other health care professionals who have treated you and, if you approve it, your family.

What safeguards are in place?

Your doctor must get a second opinion. The second doctor will check that you’re making an informed decision, read your medical file and examine you. If one or both have concerns about your mental capacity, a psychiatrist will be brought in to assess you and make the decision.

What’s an “informed decision”?

It means you understand information about assisted dying, can remember it, weigh it up, and communicate it.

I’ve been approved. What next?

Your doctor will talk to you about your condition and the likely timing to receive the medication.

There are also forms to fill out. The registrar, appointed by the Director-General of Health, will check this paperwork has been done.

If you want to change the date you’ve chosen to receive the medication, new forms must be completed.

Can I change my mind?

You can change your mind at any time.

How will the medication be administered?

At least 48 hours before your chosen date, your doctor will write a prescription for the medication.

You can administer the drugs yourself (by ingestion or intravenously) or opt for them to be administered by the doctor or nurse (by ingestion through a tube, or injection).

The doctor or nurse will stay near you until you die.

Before you’re given the medication, you will be asked if you still want to go ahead. If not, you can choose to have the medication at another date, no more than six months later.

What about life insurance?

Assisted dying won’t affect your life insurance policy.

What if you can’t make decisions?

There are two things you can put in place to cover situations when you can’t make decisions yourself.

Advance directive: This is a statement where a person sets out in advance the medical treatment they do, or don’t, want to receive. For example, you may state you don’t want to be resuscitated.

You can also state where you’d prefer to receive treatment, such as staying at home or in the hospital.

An advance directive can be verbal but it’s often better to have it in writing so your wishes are clear. You don’t need a lawyer, or anyone else, to write one up for you.

While an advanced directive indicates your wishes, it isn’t binding.

Enduring power of attorney: With an enduring power of attorney, you appoint someone, such as a relative or spouse, to make decisions on your behalf if you lose the capacity to do so.

It’s a legal document that states a person can make decisions about your care if you can’t (an enduring power of attorney can also be set up for financial matters). You’ll need a lawyer to set it up.

However, your enduring power of attorney can’t choose assisted dying for you. You also can’t use an advance directive to choose this.