Summary of the End of Life Choice Act

In this year's General Election, you can also vote in a referendum on whether you support the End of Life Choice Act.

The purpose of the Act is to give people with a terminal illness the option of legally asking for medical assistance to end their lives. They must meet the eligibility criteria to have the option.

Parliament passed the End of Life Choice Act, but it has not come into force. The Act will only come into force if more than 50% of voters in the referendum vote 'Yes'. 'Coming into force' means that the Act will start operating as law in New Zealand.

The Act uses words and language you might not be familiar with. The information below may help to explain the Act and what you can vote on in the referendum.


Terms used in the Act

About the terms used on this website and in the Act

In the Act, 'assisted dying' means:

  • a person's doctor or nurse practitioner giving them medication to relieve their suffering by bringing on death; or
  • the taking of medication by the person to relieve their suffering by bringing on death.

In the Act, 'medication' means a lethal dose of medicine used for assisted dying.

Elements of the Act

The Act is built on 4 elements.

1. Defining those who are eligible for assisted dying.

2. That the person requesting assisted dying is able to understand the nature and consequences of their decision.

3. There is free choice, without pressure, to take part in the process.

4. That a range of roles exist to oversee how the Act is working.


Eligibility

The eligibility criteria for assisted dying

To be eligible for assisted dying, a person must meet ALL of the following criteria. They 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 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.

Under the Act, a person is competent to make an informed decision about assisted dying if they can do ALL of the following things:

  • understand information about assisted dying
  • remember information about assisted dying in order to make the decision
  • use or weigh up information about assisted dying to inform their decision
  • communicate their decision about assisted dying in some way.

What's not allowed

A person would not be eligible for assisted dying if the only reason they give is that they:

  • are suffering from a mental disorder or mental illness
  • have a disability of any kind
  • are of advanced age.

A health practitioner is not allowed to suggest that a person consider assisted dying while providing a health service to that person.

An advance directive cannot be used to request assisted dying. An advance directive is a statement signed by a person setting out ahead of time what treatment they want or do not want to receive in the future.

Welfare guardians do not have any power to make decisions or take actions under the Act.


The assisted dying process

Requesting assisted dying

The assisted dying process begins with a request from the person to their doctor.

Carrying out checks — what the doctor must do

The doctor must do their best to make sure that a person's choice to receive assisted dying is made of their own free will. The doctor must carry out ALL the following checks:

1. The doctor must give the person the following information:

  • the likely course, or prognosis, for the person's terminal illness
  • the irreversible nature of assisted dying
  • the expected impacts of assisted dying.

2. The doctor must regularly talk with the person about their wish for assisted dying.

3. The doctor must make sure the person understands their other options for end-of-life care.

4. The doctor must make sure the person knows they can change their mind at any time.

5. The doctor must encourage the person to discuss their wish for assisted dying with family, friends and counsellors, and must ensure the person has the opportunity to do so. However, a person who chooses to receive assisted dying does not have to discuss their wish with anyone if they don't want to.

6. The doctor must talk with other health practitioners who are in regular contact with the person.

7. The doctor must, with the person's permission, talk with members of the person's family.

If at any time the doctor or nurse practitioner suspects a person is being pressured about their decision, they must stop the process.

The person's request is recorded in an approved form given to them by the doctor. The doctor must record the actions they have taken to comply with the checks above in this form.

The person making the request must sign and date the form. If the person is unable to write, they may ask someone else to sign and date the form on their behalf. However, the person who signs on their behalf must meet ALL of the following criteria:

  • they must not be the person's health practitioner
  • they must not be in a position to benefit from the person's death
  • they must be over the age of 18
  • they must not have a mental incapacity.

The doctor must be present when the form is signed. The form is shared with the Registrar (a Ministry of Health official who oversees the assisted dying process).

Carrying out additional checks

If the doctor decides that the person requesting assisted dying is eligible, they must seek a second opinion from an independent doctor. The independent doctor must also agree that the person meets all the criteria, which includes being competent to make an informed decision about assisted dying.

If either doctor is unsure of the person's ability to make an informed decision, a third opinion from a psychiatrist is required. The psychiatrist must complete a form outlining their opinion and provide it to the Registrar.

If a person is not eligible, they cannot receive assisted dying. The doctors, and the psychiatrist if appropriate, must explain the reasons for their opinion to the person requesting assisted dying.


What happens if the person is eligible

Selecting the timing and method for assisted dying

If the person is eligible for assisted dying, the doctor must do all of the following things:

  • tell the person they are eligible
  • talk with the person about the progress of their terminal illness
  • talk with the person about the likely timing for receiving the medication
  • ask the person to choose the date and time for administering the medication
  • advise the person that they may change their mind at any time, or choose to receive the medication at a later date
  • complete a form recording the actions they've taken and send it to the Registrar.

The person can also choose to delay the date they receive assisted dying by up to 6 months. They may also choose to withdraw their request to receive assisted dying at any time.

Before the date chosen by the person to receive the medication, the doctor must ask the person to choose 1 of these 4 methods.

1. Ingestion, triggered by the person.

2. Intravenous delivery, triggered by the person.

3. Ingestion through a tube, triggered by the doctor or a nurse practitioner.

4. Injection, administered by the doctor or a nurse practitioner.

Prescribing the medication and advising the Registrar

At least 48 hours before the chosen time, the doctor or nurse practitioner must write the prescription for the person who chooses to receive assisted dying. The doctor or nurse practitioner must advise the Registrar of the method and date chosen.

If the Registrar is satisfied that the process has been complied with, the Registrar must notify the doctor.

Administering the medication, with consent

At the chosen time for receiving the medication, the doctor or nurse practitioner must ask the person if they choose to:

  • receive the medication at that time, or
  • receive the medication at a time no more than 6 months later, or
  • stop their request to receive assisted dying.

The person can say no or delays the process

If the person wants to stop their request to receive assisted dying or does not want to take the medication at that time, it must be taken away immediately. The Registrar must be advised.

If the person wishes to receive the medication at a time no more than 6 months later, the Registrar must be advised.

The medication is only administered if the person consents

If the person chooses to receive the medication, the doctor or nurse practitioner gives it to the person. The doctor or nurse practitioner must be available to the person until they die, either in the same room as the person or nearby.

A report must be sent to the Registrar, which includes information about the person who received assisted dying and the medical staff who attended to the person.

The process is confidential

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.

Protections for health practitioners

Health practitioners are protected as long as they comply with the Act

Health practitioners who have complied with the requirements of the Act are immune from criminal and civil liability.

If a health practitioner has a conscientious objection

Conscientious objection is when a person refuses to carry out a procedure based on their personal beliefs. No health practitioner has to help a person with assisted dying if they have a conscientious objection.

If the doctor has a conscientious objection they must tell the person who has requested assisted dying, and that they have a right to ask for the name and contact details of a replacement doctor.


What oversight will there be?

Three roles within the health system will oversee the operation of the End of Life Choice Act.

1. Support and Consultation for End of Life in New Zealand (SCENZ) Group.

SCENZ would be established by the Director-General of Health and have the following responsibilities:

  • make and maintain a list of doctors who are willing to act as replacement and/or independent doctors
  • provide contact details for replacement and independent doctors when required in a way that ensures the doctor does not choose the replacement or independent doctor
  • make and maintain a list of health practitioners who are willing to act as psychiatrists
  • provide contact details for psychiatrists when required in a way that ensures the 2 doctors do not choose the psychiatrist
  • make and maintain a list of pharmacists who are willing to dispense medication under the Act; and provide contact details when required.

In relation to the administration of the medication, SCENZ would be responsible for:

  • preparing standards of care
  • advising on the required medical and legal procedures
  • providing practical assistance if requested.

2. The End-of-Life Review Committee

The Review Committee would be appointed by the Minister of Health. The Committee would be made up of a medical ethicist, a doctor specialising in end-of-life care, and 1 other health practitioner.

The Committee would:

  • consider reports provided by the attending doctor or nurse practitioner about the assisted death of a person
  • report to the Registrar on whether the information in an assisted death report complies with the requirements of the Act
  • direct the Registrar to follow up on any information contained in an assisted death report that does not comply with the Act.

3. Registrar (assisted dying)

The Registrar would be a person within the Ministry of Health, appointed by the Director-General of Health.

The Registrar's role would be to:

  • check that the processes required by the Act have been complied with
  • establish and maintain a register of approved forms, reports received from the Review Committee, and reports made to the Minister
  • receive complaints and refer complaints under the Act to the appropriate authority, such as the Health and Disability Commissioner or the Police
  • provide an annual report to the Minister of Health, who then provides the report to Parliament.

The Act will be reviewed regularly

If the Act comes into force, it will be reviewed within 3 years, with further reviews every 5 years after that. Reviews of the Act should take no longer than 6 months.


Existing rights and duties

The Act does not change existing rights and duties

Nothing in the Act affects a person's right to refuse nutrition, hydration or life-sustaining medical treatment.

Nothing in the Act affects a doctor's duty to alleviate suffering according to standard medical practice.


Insurance and other contracts

Assisted dying is treated the same as a terminal illness under insurance or other contracts

For the purpose of any life insurance or other contracts, a person who receives assisted dying is taken to have died from the terminal illness from which they suffered, as if assisted dying had not been provided.


About voting in the End of Life Choice referendum

What is the referendum question?

The End of Life Choice referendum will give you the opportunity to vote on whether the Act should come into force. 'Coming into force' means that the Act will start operating as law in New Zealand.

The referendum question is:

Do you support the End of Life Choice Act 2019 coming into force?

You can choose 1 of these 2 answers:

  • Yes, I support the End of Life Choice Act 2019 coming into force.
  • No, I do not support the End of Life Choice Act 2019 coming into force.

What happens after the vote?

If more than 50% of people vote 'Yes' in the referendum, the Act will come into force 12 months after the final result is announced.

If more than 50% of people vote 'No' in the referendum, the Act will not come into force. It will not start operating as law in New Zealand.


Further reading to help you make your choice

More detail on the End of Life Choice Act 2019

You can download and read the Act in full.

Read the End of Life Choice Act in full


Cannabis legalisation and control referendum

At this year's General Election, you'll also be given the opportunity to vote in a referendum on the recreational use of cannabis.

Learn more about the cannabis legalisation and control referendum