Guidance on the End of Life Choice Act and Assisted Dying
From 7 November 2021 people who experience unbearable suffering from a terminal illness will be able to legally ask for medical assistance to end their lives.
The End of Life Choice Act 2019 sets out the legal framework for accessing assisted dying, including eligibility criteria and safeguards.
Assisted dying is not a replacement for palliative care or health care services more generally. It provides another option for people with a terminal illness in certain circumstances.
The Ministry of Health will be responsible for the Act and has a programme underway to implement the assisted dying service.
Key points for paramedics:
Firstly, follow the guidance and policies of your employer on responding to assisted dying within your workplace.
It is illegal for paramedics to raise the topic of assisted dying with patients
Only a patient can raise the topic of assisted dying
Only a doctor or nurse practitioner can provide an assisted death
Assisted dying is not an acute service. There is a well-defined process that must first be followed in order to determine eligibility
If assisted dying is raised by a patient, paramedics must:
Respond professionally, with compassion and empathy, and without bias.
Connect them to a doctor who is willing to provide assisted dying services, or
Encourage the person to discuss assisted dying with their doctor, nurse, palliative care team, or with staff at the emergency department or facility to which they may be transported, or
Provide information on contacting the SCENZ Group (Support and Consultation for End of Life in New Zealand)
To be eligible, a person must meet all the following criteria:
Aged 18 years or over
A citizen or permanent resident of New Zealand
Suffer from a terminal illness that is likely to end their life within 6 months
Be in an advanced state of irreversible decline in physical capability
Experience unbearable suffering that cannot be relieved in a manner that the person considers tolerable
Competent to make an informed decision about assisted dying.
A person cannot receive assisted dying solely because they are suffering from a mental disorder or mental illness, have a disability, or are of advanced age.
A person cannot use an advance directive to request assisted dying. An advance directive is a statement setting out ahead of time what treatment they want, or do not want to receive in the future at a time when they are no longer competent to communicate their wishes.
A person requesting assisted dying must be competent to confirm their decision to receive an assisted death at the time the assisted death is provided.
Both the medical practitioner treating the person and a second, independent medical practitioner must agree that the person is eligible for assisted dying. If either medical practitioner is unsure of the person's competence to make an informed decision, a psychiatrist must also assess the person to confirm their eligibility.
Assisted dying will generally be provided in home and community settings. Paramedics do not have a formal role under the current legislation, but their role within communities and with people nearing the end of life may bring them into contact with a person at some stage in their assisted dying journey.
A person considering an assisted death is in a uniquely vulnerable stage in their life. The involvement of whānau and loved ones (with consent) is important, and patients should be supported to receive any cultural, spiritual or psychosocial care that is needed and available.
Right 4.5 of the Code of Health and Disability Services Consumers’ Rights requires health services – including paramedics - to work together to ensure quality and continuity of care.
All patients must have quality, compassionate and patient-centred care at whichever stage of life they may be.
About the End of Life Choice Act 2019
Assisted Dying: Rights and responsibilities under Code of Health and Disability Services Consumers’ Rights
The Ministry of Health’s End of Life Choice Act implementation page
Care pathway for health practitioners (not including medical practitioners) this broad guidance covers paramedics
Responding when a person raises assisted dying – A HANDBOOK for registered health professionals.
Responding when a person raises assisted dying – A CONVERSATION GUIDE for registered health professionals.
Assisted dying care pathways for health practitioners
Preparing for assisted dying services – Information for health service providers.
Te Tiriti o Waitangi and assisted dying implementation
Paramedics and ambulance personnel are encouraged learn more and enrol in the Ministry of Health’s End of Life eLearning modules.