After decades of debate, on November 7 the End-of-Life Choice (EOLC) Act 2019 became Law, and this choice is now available.

This follows the binding referendum in 2020, in which 82% of those eligible to vote did so, and of those 66% supported EOLC. 

The Ministry of Health (MoH) have had only one year to set up the new systems the EOLC Law requires; that they have done so while struggling with Covid 19, is a credit to them. The various committees and appointments have been made; these are posted on the MoH website. 

Multiple Zoom meetings and trainings have been held, I have joined some of these and they have been very good. Now, the Medical Aid in Dying (MAID) system is ready to go, we have over 100 medics, several clinical nurse practitioners, several psychiatrists, numerous nurses and several pharmacists who have completed the provider trainings. 

We also have a small number of dying people who have already started talking to their doctors.

Special funding has been designated and ring fenced; the service is free for those who access it. This funding does not compete with funding for other health care services, nor with funding for Hospice/Palliative Care, (H/PC) which continues to be significantly underfunded. Interestingly, there is some hope that the introduction of MAID may encourage better funding for H/PC, this has happened overseas. Another hope is that over time, MAID will be incorporated into the spectrum of end-of-life care in Aotearoa, as is happening in other jurisdictions. 

Hospice New Zealand and its members remain opposed, which may create some tensions as they are out of step with 2/3 of the population. Thank heavens for James Jap and Tina McCafferty of Totora Hospice, who state clearly and publicly that they respect the EOLC Law which reflects the will of the people of Aotearoa and see no reason why MAID should not be included as an option in the Patient Centred care which they provide.

The Catholic Church remains staunchly anti but has issued a statement affirming that Catholic medical and nursing staff, while they will not perform MAID, or allow it in their institutions, will not obstruct or abandon the patients who make this choice. 

Using overseas jurisdictions as a guide, it is estimated that of the approximately 35,000 deaths each year in Aotearoa, only a small number, fewer than 1%, will need to make this choice. 

For most of us, most of the time, good H/PC, is enough. However, the small number of unfortunate dying people – recognised as making up 5-10% of H/PC patients – whose suffering is unbearable to them, even with the best H/PC, have been a significant part of the motivation for those of us pushing for law change. A bad death casts a long shadow, terrible for the dying person and torture for those who love and care for them. 

Small wonder that there is palpable relief that we have got to this place. A significant number of us who choose to access the legislation, may not need to use it, the relief of knowing we can, is palliation in itself, removing much of the uncertainty and fear and enabling living until we die.

While we assimilate this new choice, I think it is reassuring to consider experiences from those who have been providing MAID elsewhere in the world. Many people from our closest neighbour Victoria and from Canada, have been very generous in sharing their experiences, advice, thoughts and feelings. What has struck me is the consensus that this is a privilege for those involved – peaceful, humbling, rewarding and life changing – just like H/PC. 

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5 Comments

  1. Mīharo! This is a great achievement for all those involved. Ngā mihi/thank you for allowing whanau to face terminal illness with dignity rather than doubt. It would have saved our family heartache and pain if this act had been available 7 years ago when my husband and father of 5 felt he had to take his own life rather than face an unbearable death after suffering 10 years of terminal illness
    Ngā mihi nui

  2. I can’t understand H/PC holding out against assisted dying. Anecdotal and data-driven evidence clearly show that a percentage of patients in their care suffer badly as they die, yet H/PC continues to reject the only possible alternative that would bring relief – i.e. assisted dying. What is “holistic” and “non-judgmental” about that?

  3. Thank you, Dr Libby, for a thoughtful and well written article. A bad death does indeed leave a long shadow and traumatic memories of a loved one’s life that should have ended more gently and peacefully.

  4. I still have ethical, moral and philosophical doubts and reservations about this bill, and the euphemistic language used around it, i.e. “assisted dying”. Let’s call a spade a spade – it is, in reality, helping people commit suicide. And just because 2/3 rds of the people who voted in the referendum (which doesn’t necessarily equate to 2/3rds of the population) voted for the bill, that doesn’t make it right. It further raises the huge question of why we put so much effort into combatting suicide in society, when, to play devil’s advocate, those who do that are suffering unbearably? Yes, people who will choose to die in accordance with this bill may be suffering, but so are countless others around the world, in far more harrowing and unbearable circumstances than in our western, so-called civilised, society. Suffering is a part of life, and life itself is a terminal condition, to be blunt. Having said that, I respect the fact that the bill is now in effect, and that people have the legal right to assisted suicide if they so desire. That’s my rant for the day…

  5. Libby has moved the issue into the practical realm.

    It is a bit crass, but I think MAID will save taxpayers money, reducing suicidal car crashes. No need to call out police, ambulance, and fire and then get a coroner’s report. No anguish for witnesses.

    I think MAID will extend the lives of partners, who are no longer worn down by caring for a dying partner (the common saying “what a loving couple” the partner died within 6 months). We have seen a buddy who put off her own knee surgery to care for her husband. He has died and she is hoping the planned surgery will go ahead this month. If no surgery her life will be negatively affected and perhaps her life shortened. MAID saves lives.

    Thanks

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