The proposed rules
How assisted dying would work
The referendum will ask whether or not you support the End of Life Choice Act 2019. The Act outlines how assisted dying would work, who would be eligible, accountability measures, and the rights of patients.
If the yes vote wins, the law will come into effect one year later. If the no vote wins, the law will not change.
Assisted dying could only be done with a lethal drug
Assisted dying would either be performed by a medical or nurse practitioner administering a lethal dose of a drug to the patient or by providing a lethal dose of the drug for self-administration. It would have to be administered orally, intravenously, or by injection.
Other methods of assisted dying would not be legal, but the refusal of medical treatment and nutrition would remain legal.
Only certain people would be eligible
The only people eligible for assisted dying would be those suffering from a terminal illness likely to kill them within six months, in an advanced stage of irreversible physical decline, and undergoing unbearable suffering with no option to relieve that suffering in a way that they consider tolerable.
All of these requirements would have to be met for a person to be eligible for assisted dying. A person would not be eligible just because they were mentally ill, disabled, or of advanced age.
Assisted dying would only be allowed for NZ citizens or permanent residents aged 18 years or older.
Patients would have to be competent to make an informed decision
A patient would have to be competent to make an informed decision about assisted dying. This means they must be able to understand, retain the information to make the decision, weigh up that information, and then communicate their decision.
The patient’s decision would have to be their own
The medical practitioner would have to do their best to ensure that the patient is making their decision about assisted dying free from pressure from any other person. To do this, the medical practitioner would be allowed to talk to other health practitioners in regular contact with the patient and with approved members of their family.
If the attending medical practitioner suspected a patient was being pressured into assisted dying they would have to stop the process immediately.
A patient’s welfare guardian would not have the power to make the decision about assisted dying for that person. Patients would not be able to make requests for assisted dying in advance directives, such as in “a living will”, which is sometimes used to tell others of your wishes if you become incapacitated.
Patients could change their mind
A patient would be able to cancel or delay their assisted death at any point before being given a lethal dose of the medication.
The patient would be able to do this orally, in writing, or with a gesture. They would be able to cancel even if a legal document like a contract or advance directive says otherwise – requests for assisted dying could not be made through advance directives in the first place
If the patient wanted to delay or cancel their request, then the attending medical practitioner would have to immediately take the medication away.
Medical practitioners could not suggest assisted dying
Medical practitioners would not be allowed to suggest or even bring up assisted dying with a patient. But they could discuss assisted dying and provide information at a patient’s request.
Patients would need to be informed about their options
Before confirming a patient’s request for assisted dying, the attending medical practitioner would have to ensure the patient has relevant information about their options.
They would have to tell the patient about the prognosis (the likely outcome) of their terminal illness, the irreversible nature of assisted dying, and the likely impacts of assisted dying.
They would also have to regularly communicate with the patient about their request, ensure the patient knows about other options for palliative care, and ensure the patient knows they can reverse their request.
The medical practitioner would have to encourage the patient to discuss their request with friends and family, and allow them the opportunity to do so. They would have to ensure the patient knows they do not have to discuss their wish with anyone.
There would be rules about how the decision to die is made and carried out
Once the steps above are carried out, a form would need to be signed to confirm the patient’s request.
Both the attending medical practitioner and an independent medical practitioner would have to give their opinion about whether the patient was eligible for assisted dying. To continue, both would need to agree that the patient is eligible.
If both agree, but either of them are unsure about the patient’s competence to make a decision, then a psychiatrist would have to give an opinion about whether the patient is competent to decide. If the psychiatrist does not believe that the patient is competent the process would end.
The attending medical practitioner would then inform the patient of the medical opinions given. They would also discuss the progress of the patient’s terminal condition and tell the patient they can change their mind at any time.
The patient would then choose the date, time, and method for administration of the drug. This could be changed later on by the patient.
The registrar for assisted dying would have to check that all these steps were properly followed before allowing the process to continue.
At the time of administration, the attending medical or nurse practitioner would have to confirm whether the patient wants to continue, delay, or cancel their request for assisted dying.
If the person wants to continue then the attending medical or nurse practitioner would have to administer the drug and remain with or nearby the patient until death. If the person does not want to continue, then the drug must be immediately taken away.
A report with information about the death would then be passed onto the assisted dying review committee.
Medical practitioners could conscientiously object to assist dying
If a patient makes a request for assisted dying, a health practitioner could decline to assist on conscientious grounds, such as that they don’t agree with assisted dying.
The practitioner would have to tell the patient of their objection and of the patient’s right to find another medical practitioner.
Employers would not be able to punish an employee simply because they conscientiously object to assist dying. Nor could they reward an employee for agreeing to assisted dying.
It would also be illegal to publicise information about the method, place, and practitioners involved in assisted dying.
There would be accountability measures
A registrar would be created to keep records of each step of every assisted dying process. They would be responsible for reporting complaints about assisted dying to the Health and Disability Commissioner and the police, and preparing an annual report for the relevant minister and parliament.
A review committee would be set up to review assisted dying reports and inform the registrar on whether an assisted death has complied with the law. They could then direct the registrar to investigate further if the committee believes there has been unsatisfactory compliance. The committee would be made up of a medical ethicist and two medical practitioners.
The Support and Consultation for End of Life in New Zealand (SCENZ) Group would be created to set standards of care during the administration of medication, and to provide medical, legal, and practical support. It would also keep a list of names and contact details of medical practitioners, psychiatrists and pharmacies willing to assist dying.
The law would be regularly reviewed
Three years after the passing of the End of Life Choice Act, and then every five years after that, the Ministry of Health would have to review the operation of the law and consider if it should be changed.
More information
Read the government’s summary of the End of Life Choice Bill
Read the government’s list of frequently asked questions
Read the End of Life Choice Act
Read the decision of the High Court in Seales v Attorney General
