End Of Life Choice Referendum

This year, we get to have our say on whether or not assisted dying should be legal for those who wish to end their life in specific situations. If this topic is a sensitive one for you, please know that there are people you can contact for support. Talk to loved ones if you can and if you need a safe space to reach out to any of these are great places to turn to: 

Youthline – Free call 0800 376 633, free text 234, email talk@youthline.co.nz or Web chat from 7pm–10pm
thelowdown.co.nz – or email team@thelowdown.co.nz or free text 5626
Healthline – 0800 611 116

End of Life Choice, assisted dying, euthanasia - these terms are the same and can be used to describe this referendum. To keep it easy, we’re going to stick with the End of Life Choice Referendum. For reference, this is the official Government term too. This may seem a little dark, however, the intention is to allow people in certain select situations to have the option not to live. We’ll get to exactly what those situations are in just a moment, but first, there’s the small matter of the referendum question. The referendum is a yes or no question: Do you support the End of Life Choice Act 2019 coming into force?

So what is this ‘Act’ they’re talking about? This is a piece of proposed law which is already written and waiting for a decision on whether or not it will come into action. As it is a sensitive issue, the Government wants to know whether the public support it or not beforehand. Bear in mind that there are some strict rules in place surrounding how, when, who and where this can happen. Sound confusing? Hopefully this helps.

The most important part of this Act is that assisted dying would only be available to those with terminal illness. This is because when you have a terminal illness, your life expectancy isn’t normally that long. If the amount of time left is likely to be quite painful for the individual, they may wish to end their life before they have to endure too much pain. 

If this Act was to become law 'assisted dying' means a doctor or nurse practitioner giving someone medication to relieve their suffering by bringing on death or the taking of medication by the ill person to relieve their suffering by bringing on death. ‘Medication' means a lethal dose of the medication which causes death. 

To be eligible to have the End of Life Choice, you must meet ALL of these criteria:
- be aged 18 years or over;
- be a citizen or permanent resident of New Zealand;
- suffer from a terminal illness that's likely to end your life within 6 months;
- have significant and ongoing decline in physical capability;
- experience unbearable suffering that cannot be eased;
- be able to make an informed decision about assisted dying by yourself (mentally sound).

You would be unable to ask for assisted dying if the only reasons you’re able to give are:
- relating to a mental disorder or illness; 
- relating a disability of any kind; 
- Or relating to being of an older age.

Welfare guardians are unable to make the end of life choice, it has to be your own. An advance directive (essentially a pre-planned document which gives your consent for certain treatments, such as chemotherapy for cancer) cannot be used to make an end of life choice. It must be verbal and it must follow the process described below. 

You are only able to make an end of life choice if you can make an informed decision. This means you are able to:
- understand information about assisted dying;
- remember information about assisted dying in order to make the decision;
- use or weigh up information about assisted dying when making your decision;
- And be able to communicate their decision in some way.

In order to go ahead with the assisted dying process, you will have to see a few different doctors and/or health practitioners. First, of course, you would approach your personal doctor. There would be an ongoing conversation with your doctor about this decision. They are required to talk to other health professionals who are in regular contact with you and with your permission, your family. Doctors have to leave a paper trail (write up paperwork) showing that they are meeting all the steps listed. If your doctor conscientiously objects (feels they cannot be a part of an assisted dying plan for you or refuses to give this treatment at all) there would be a range of doctors who are willing and able to become a doctor for you. 

They would then book you in to see an independent doctor. Both doctors must agree that you meet all the criteria, including being able to make an informed decision about assisted dying. When making this decision, both doctors must do their best to make sure that your choice to ask for assisted dying is your own. If either doctor is unsure of your ability to make that decision, a psychiatrist will need to assess you. 

If, at any time, a doctor or nurse practitioner thinks you are being pressured into or about the decision, they must stop the process. Under no circumstances can a health practitioner (doctor, nurse, surgeon, etc.) suggest that someone should consider assisted dying when providing a health service to them. Assisted dying must be a decision reached by the individual and not mentioned by a health professional first. 

If it is decided that you are eligible, you are then able to choose a method, date, and time for taking the medication required. You can also choose to delay the date you receive assisted dying by up to 6 months. You may also choose to withdraw your request to receive assisted dying at any time. 

When it comes time to take the medication, the doctor or nurse practitioner who is administering it must ask the person if they still choose to take the medication. If you still want to take it, the doctor or nurse practitioner will give it to you. The doctor or nurse practitioner must then remain with you until you pass away.

There are four methods that you are able to choose from:
- Ingestion, triggered by the person.
- Intravenous delivery (vein delivery), triggered by the person.
- Ingestion through a tube, triggered by the doctor or a nurse practitioner.
- Injection, administered by the doctor or a nurse practitioner.

If you change your mind, and no longer wish to go ahead with the assisted dying, the medication must be taken away.

The whole process is confidential and overseen by a Ministry of Health registrar (kind of like a judge in court - someone who oversees the whole process from both sides). No person may make public:
- the method by which assisted dying was received;
- the place the medication was administered;
- the name of the person who administered the medication or their employer.

There are specific parts set out in the Act ensuring that the medical professionals who choose to aid people with their decision and administration are protected. There is also a specific set of guidelines surrounding insurance for both the individual and health practitioners. Due to the delicate nature of this Act, it would be reviewed regularly. 

The bottom line is simple: If you are not eligible, you cannot receive assisted dying.

References: 

https://www.referendums.govt.nz/endoflifechoice/index.html

https://www.referendums.govt.nz/endoflifechoice/summary.html