The Front Page: Complex questions about NZ's euthanasia laws

Important questions linger about NZ's euthanasia rules. Photo / Getty Images

Assisted dying only became available to New Zealanders in November last year, but there are already signs that the rules may need to evolve.

A new report shedding light on applicants, rejections and complaints poses some important questions about how the rules are actually put into practice.

The Herald's social issues reporter Isaac Davison tells the Front Page podcast that concerns about euthanasia law creating a slippery slope of assisted dying have simply not come to fruition.

"The more headline-grabbing arguments against legalisation have not played out so far," says Davison.

"The idea that it would be death on demand and that you might have a rush of deaths hasn't eventuated."

On the contrary, New Zealand has some of the most restrictive euthanasia legislation in the world - and this is a central area of contention.

Davison says that one of the key observations from this first report from the Ministry of Health is that the ineligibility rate is high and that some people are potentially being turned away when they should qualify.

Most people are being rejected because they don't meet the specific requirement of having a terminal illness that is likely to kill them within six months.

This scope is far narrower than what was initially intended by MP David Seymour when he presented the Bill to Parliament.

"The original definition was that if someone had a grievous or irremediable condition that they would be able to get access to assisted dying," explains Davison.

"That would mean that someone with motor neuron disease could get approval. But David Seymour says he agreed to narrow it partly to get the Green Party on side to make sure the bill would actually pass."

While the data available is still quite limited, Davison says there is already some discussion about whether the rules might need to broaden when the legislation is reviewed in 2024.

The bigger question is whether the public would have the stomach for those rules to be broadened.

"It's hard to tell," concedes Davison.

"There was obviously large support for the bill, with 65 per cent of the public voting for it in the referendum. While there is support broadly for voluntary euthanasia, it's less certain whether that support would extend to a broader regime."

The other problem hanging over the legislation is that not all doctors are on board with euthanasia, meaning that access to the procedure could be limited in some regions.

"So far 130 doctors, nurses or medical staff have signed up in New Zealand, which sounds like a low number, but the Ministry says it's been sufficient for demand," says Davison.

"So far there are gaps in the system, in terms of rural areas in that you need a doctor's approval and then a second independent doctor to give their approval too."

Davison says that this does point to broader staffing issues rather than specifically to euthanasia, and the legislation does make provisions for telehealth when needed.

"One interesting thing about this is that in New Zealand, doctors can do assessments via Zoom. That's not possible in some other countries, where it would be considered aiding and abetting suicide.

"But from my understanding, most doctors prefer to do it in person. They're going over and above. They're doing five-hour round trips to do these consultations."

Given the growing prominence of telehealth, this is another issue that the health sector will have to keep a close eye on in the coming years.

Davison says that these are only some of the questions that we'll need to ask in the coming years, as euthanasia becomes more prominent in society.

"It's still early and a lot of the impact just won't be apparent yet. In particular, how it works with palliative care as well as issues for the Māori community.

"Euthanasia systems have been set up in the Western frameworks and there's not much experience of euthanasia and how it might apply to indigenous cultures. And there's also concern within the disabled community because they feel the legislation places a different value on people's lives."

Euthanasia might be legal in New Zealand, but the discussion about the practice and how it's applied is far from over.

• The Front Page is a daily news podcast from the New Zealand Herald, available to listen to every weekday from 5am.

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