The Ministry of Health has accepted the irrefutable evidence. It has published its statutory three-year review of the End of Life Choice Act and made several recommendations to curb conscientious objection – both individual and organisational – when this extends to obstructing a patient’s rights.
The End-of-Life Choice Society, an advocacy organisation for assisted dying law, has received numerous complaints of deliberate obstruction by individual practitioners, faith-based care facilities and hospices. Assisted dying research groups, medical practitioners and affected families that made submissions to the review have reported the same.
So what form does this obstruction take? Individual GPs and specialists can make it difficult for patients who ask about assisted dying by providing only the minimum information that the act requires: that they have a “right to ask the SCENZ Group [Support and Consultation for End of Life in New Zealand] for the name and contact details of a replacement medical practitioner”. SCENZ? Without access to the internet and the health literacy skills to search online, some seniors and socio-economically disadvantaged patients are effectively stymied.
Organisational conscientious objectors are even more powerful. They can “not understand” what the patient is requesting, or they can considerably delay their response. When a patient is only weeks away from death and, given that the process of applying for assisted dying takes an average of 18 days, this is effectively denial of service.
Another tactic is to persuade the patient that assisted dying is very difficult to obtain and that their application would have little prospect of success.
Hospices can press a patient who has applied for assisted dying to continue with maximum doses of medication, which could lead to loss of mental competence. Mental competence up to the last minute is required under the act.
One family commenting on a health practitioner told the ministry review: “I actually believe that their attempt at intervention was aimed at delaying [X]’s attempt at assisted dying, knowing that at some point he would not be able to communicate consent. The impact it had ruined our final week with our dad.”
Finally, hospices and aged-care facilities can insist that the dying patient be removed from their premises, irrespective of the hardship this causes.
Assisted dying is reserved for those whose medical condition is incurable, progressive and has brought them to an “advanced state of irreversible decline in physical capability”. Their death must be foreseeable and their situation must be one of “unbearable suffering that cannot be relieved”.
Ministry of Health data shows that at least 75% of applicants for assisted dying are already receiving palliative care at the time of applying. Hospice NZ CEO Wayne Naylor has been quoted as saying that nine out of 10 people die well. He is correct. But for that one patient in 10 (10% of our annual 40,000 deaths), assisted dying may be needed and wanted.
The End-of-Life Choice Society strongly supports better funding for palliative and hospice care. It is perfectly possible for palliative care and assisted dying care to work co-operatively together, as is done elsewhere in the world. Each discipline plays its part separately but collaboratively. Assisted dying doctors and their patients want and need this situation to come about sooner rather than later.
The government is not required to act on the ministry’s recommendations and at this stage it doesn’t look as if it will. Meanwhile, an Act MP has put a member’s bill to widen access to assisted dying into the parliamentary ballot but it’s not guaranteed to be introduced to the House.
Ann David is president of the End-of-Life Choice Society NZ
