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.