The End of Life Choice Act will come in to force on November 7. Photo / Getty Images
A Euthanasia lobby group says many people think assisted dying is about "turning off machines" and has called for greater safeguards in the End of Life Choice Act.
On November 7 the Act will come in to force, meaning a person who wishes to receive assisted dying and thinks they meet the eligibility criteria can ask a health practitioner about the process.
But several Bay of Plenty hospices have taken a "conscientious objection" to the Act and will not be offering assisted dying services.
The Ministry of Health says assisted dying services are expected to be provided in a person's home or other community settings rather than in hospital settings. There were also several safeguards in place to protect those seeking and providing the service.
Lobby group Euthanasia Free NZ executive officer Renee Joubert said the group was "very concerned" about the Act coming in to force.
"Our concerns are that compared to overseas laws, greater safeguards are missing, for example, there are no witnesses required," she said.
"We also found that, even up to and after the referendum, people didn't really know what they were voting for.
"Many people still think that assisted dying is all about turning off machines."
Joubert said the group was concerned when people asked for assisted dying, "they may not know what they're actually asking for".
A Ministry of Health spokesperson said safeguards included providing the service only to those who met the eligibility criteria and had made their decision free of coercion.
The person must be assessed against the eligibility criteria by two medical practitioners, including one deemed to be independent.
If required, a psychiatrist will also assess the person's competency to make an informed decision, the spokesperson said.
"Robust" processes were in place to ensure services were high quality and included appropriate support for people and practitioners.
The service would only be provided by "suitably skilled and competent practitioners" and ensured people would not be subjected to prosecution by seeking or providing assisted dying.
The Act allowed health practitioners to adopt a conscientious objection. Patients could ask the Support and Consultation for End of Life in NZ (SCENZ) group set up by the Ministry of Health for contact details of a replacement health practitioner.
Tauranga's Waipuna Hospice chief executive Richard Thurlow said it would not provide assisting dying.
The hospice did not believe assisted dying was a part of palliative care, so it was for a "suitably adequately trained professional" to do the procedure, Thurlow said.
Those who chose the procedure would be directed to SCENZ. The hospice would also explain the benefits of palliative care as they progressed through their last weeks, months and days of their life, he said.
But anyone who had chosen the procedure and still wanted to use their services would be welcome to do so, he said.
"We will be caring for people up to and after they might have chosen assisted dying.
Rotorua Community Hospice chief executive Jonathon Hagger shared Thurlow's stance.
"The philosophy of hospice is neither to hasten nor shorten life – we believe that death and dying is a natural process and we'll let that process play out at its own time."
The hospice would still care for patients who had chosen the assisted dying procedure and their families, and would discuss a timeline and care plan that suited everybody's needs, he said.
Hospice Eastern Bay of Plenty chief executive Peter Bassett said the hospice had also taken a conscientious objection.
"We'll still provide palliative care services up until the point that the person wished to be referred to a member of SCENZ."
Age Concern Tauranga general manager Tanya Smith said it was important people started educating themselves to get a better understanding of available options.
"Start having conversations around what is available out there."
Tauranga Grey Power president Jennifer Custins said the organisation did not take a stance on the Act because it was a personal choice.
Some individual members on behalf of Grey Power made submissions at the time about the Act, she said.
"We did everything we could to make sure that the law was going to protect the older age group."
A Lakes District Health Board spokeswoman said the DHB had been part of the national working group contributing to new policies and procedures relating to the Act.
Policies were being localised to the Lakes DHB's "specific environment".
"We are being directed by the Ministry of Health as they are leading the implementation."
Multiple sessions had been set up to provide education around the Act which complemented the resources available from the Ministry of Health.
A Ministry of Health spokesperson said policy guidance had been developed for health service providers and district health boards to support them if someone requested assisted dying.
Providers could tailor this guidance to their own context and level of involvement in providing assisted dying services, the spokesperson said.
The person must be the one to raise assisted dying with someone in their health care team. A health professional cannot suggest it as an option.
Not everyone with a terminal illness will be eligible for assisted dying. The Act states that to be eligible, the person must meet all of the criteria. The person must be:
• Aged 18 years or over.
• A citizen or permanent resident of New Zealand.
• Suffering from a terminal illness that is likely to end their life within six months.
• In an advanced state of irreversible decline in physical capability.
• Experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable.
• Competent to make an informed decision about assisted dying.
• A person with a disability or mental illness can access assisted dying if they meet the above criteria. A person can't access assisted dying solely because they have a mental disorder or mental illness, have a disability or are of advanced age.
More than 44 operators affected, including Tio Ohiwa and Kohutapu Lodge.