The End of Life Choice Act passed in a binding referendum during the 2020 General Election. The Act makes it legal for certain terminally ill adults to request medical assistance with dying from 7 November 2021. The Ministry of Health is responsible for the Act and has a work programme to implement it. Information about this can be found on the Ministry of Health website (www.health.govt.nz).
Palliative care is an area of health care focused on affirming life and helping people with very serious or life-limiting illnesses live as comfortably as possible until natural death occurs. This means palliative care focuses on “Living Every Moment”, rather than shortening or lengthening the dying process.
Hospice Southland’s mission is not changing. Hospice Southland does not take any action to cause patients to die sooner than they would naturally.
Assisted dying is not part of palliative care, therefore it will not be provided at Hospice Southland or by Hospice Southland staff. This includes the assessment process for assisted dying. The process for assisted dying is being coordinated by the Ministry of Health. (www.health.govt.nz).
However, Hospice Southland respects that people may have different beliefs and experiences. Hospice Southland will not turn away patients who support the concept of assisted dying or who are considering an assisted death, and we will continue to offer specialist palliative support to all who need and want it.
However, we will not be a party to an assisted death, nor will we allow it on our premises.
> To read about how the the End of Life Choice Act came about, please click here.
Our key concerns with the Act are listed below.
The End of Life Choice Act would profoundly and fundamentally change the role of doctors in New Zealand from that of healers companioning patients and families/whanau through the dying process to that of agents who can legally bring about premature death for certain patients.
The Act places clinical, administrative, legal, ethical, and moral responsibility for the process and consequences almost exclusively on individual doctors without mention of education, training, and support. If assisted dying is legalised, it should be a health system issue and not the responsibility of individual doctors.
Doctors are not ideally suited to identify and address issues of possible coercion when it comes to requests for assisted dying. Further, the Act specifies that patients must select a particular date and time to receive assisted dying, which could be considered a form of coercion.
Many terminally ill patients who express a desire for an assisted death do so out of concerns that they will be a burden to others or lose control or dignity, and not for physical symptoms like pain. In US states where assisted suicide is legal, many who request assisted dying never actually take the prescribed medication.
By mandating a set date and time for an assisted death, the Act could arguably be seen as legislation that would lessen a terminally ill patient’s sense of control over his or her illness and death.
The End of Life Choice Act outlines a process for assisted death but does not offer funding or support for other end of life care options. Hospice Southland urges voters to instead support measures that improve funding for and equitable access to symptom management medications, illness screening and treatments, hospice and palliative care, mental health services, aged residential care, and home-based supports.
The Act emphasizes autonomy (the right of individuals to choose what happens to themselves) but does little to consider other ethical principles like beneficence (doing what is best for patients), non-maleficence (avoiding harm to patients), justice (doing what is best for society), and Maori tikanga and kawa.
If the Act becomes law, family, friends, whanau, and community supports would only be brought in to support a patient who requests assisted dying if the patient allows that involvement.
Patients could potentially request and receive an assisted death without any emotional, relational, or spiritual support. Isolated, depressed, and lonely patients may be more likely to see an assisted death as their only viable option for end of life care.