Assisted dying offers patients ‘control’

26 Nov 2021 10:36 AM | EOLC Admin (Administrator)

Source: NZ Doctor

Zahra Shahtahmasebi introduces the specialist GP who will have oversight of every assisted death in New Zealand

Specialist GP Kristin Good, registrar of the new assisted-dying service [Supplied]

Criteria, End of Life Choice Act 2019

The act contains six criteria, all of which must be met. The person must:

  • be aged 18 years or over
  • be a citizen or permanent resident of New Zealand
  • suffer from a terminal illness that is likely to end their life within six months
  • be in an advanced state of irreversible decline in physical capability
  • experience unbearable suffering that cannot be relieved in a manner the person considers tolerable, and
  • be competent to make an informed decision about assisted dying.

New Zealanders who were waiting for the End of Life Choice Act 2019 to come into force have already got their applications in to the new assisted-dying service.

The Ministry of Health has received two formal applications currently, with a number “still in the process”, says group manager, quality assurance and safety Emma Prestidge.

Newly appointed registrar, specialist GP Kristin Good is expecting only half will meet the criteria and, of those eligible, only a small proportion will go on to access assisted dying.

This is because for some, having the choice in their back pocket is all they need, she says. “It gives them greater control, after feeling disempowered. Having the choice means they don’t necessarily need to go through with it.”

Dr Good is the ministry’s chief clinical advisor, health system improvement and innovation, and took up her additional role as registrar on 7 November.

She says applications will take four to six weeks for the person’s eligibility to be determined. This also includes the time to match the person with a practitioner, and conduct assessments.

“From the moment they apply, it feels very urgent to them, they want a fast process, but for us, quality is paramount.”

Once eligibility has been confirmed, the patient can choose an appointment date for the lethal medication to be administered within six months. They can bring it forward at any point, or extend it by another six months.

So far, the total number of practitioners who have given an expression of interest to join the Support and Consultation for End of Life in New Zealand (SCENZ) Group’s list of providers is 131. The group is the statutory body for the assisted-dying service, responsible for maintaining the list of providers and providing contact details of practitioners.

The list is mostly GPs, palliative care physicians and oncologists, with the remainder made up of 13 psychiatrists, and 10 nurse practitioners. Ms Prestidge says 95 have indicated they will be interested in being an assisting medical practitioner, 91 an independent medical practitioner. She adds that as all doctors can potentially do multiple roles, even the psychiatrists, this explains the overlap seen across the two categories.

One-third of them are located in the South Island and two-thirds in the North, and 70 per cent have indicated they are able to travel. This is essential, as the ministry is not expecting providers will be located in every area, says Dr Good.

A number of GPs have indicated interest, not in being on the SCENZ list, but in providing assisted dying for their own patients. Although these GPs do not have to register, doing so allows the group to work hand in hand with the practitioner and provide support.

Health professionals have registered with SCENZ in larger numbers than she expected. She is aware assisted dying is a polarising topic, and many health professionals would have voted against it in the 2020 referendum.

But, as the legislation has started to be implemented in the past year, some have begun to change their minds.

Dr Good is also surprised by the speed at which health professionals have taken up the training. “If you compare the numbers, we have 131 whereas Western Australia has eight.”

At one end of the spectrum are people interested in providing the service, possibly due to their own experiences with patients or family members, and at the other end are those who will never consider it, says Dr Good.

In the middle are those who are not conscientious objectors, but who don’t see assisted dying within their scope of practice. For these practitioners, the long-term patients may change their minds, she adds.

“When they come to you and say ‘will you do this for me’, some are starting to see assisted dying as the next step in their continuity of care – they hadn’t considered it until now.”

Dr Good was formerly clinical director COVID response at national telehealth service Whakarongorau Aotearoa, joining the ministry in February. As registrar, she has oversight of every assisted-dying case to ensure that every single requirement under the legislation has been met, before the doctor gets the medication.

She will also be involved with reporting and managing complaints, working closely with the Office of the Health and Disability Commissioner, the medical and nursing councils of New Zealand, and police if required. Death reports will be filed by the health professional within 14 days of the death. The registrar is based within a secretariat, mostly staffed by senior nurses who support service provision and provide advice.


Comments

  • 26 Nov 2021 11:51 AM | Anonymous
    Thanks to the compassionate doctors who have completed training in readiness to help patients in desperate need. They are true health partners.
    Link  •  Reply

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