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GP sets out practicalities of End of Life Choice Act, if voted for in referendum

Kiwis will be able to vote on whether or not to bring into force the End of Life Choice Act 2019 by voting in the referendum in the General Election.

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Dr John Cameron outlines some of the practicalities of the bill from a health professional’s perspective. Source: Q+A

The referendum is binding, meaning if more than half of voters in the general election choose “yes”, the End of Life Choice Act becomes law. Voters can vote "yes", "no" or abstain from voting.

The medical community is divided in its position on assisted dying. 

The Medical Association opposes the act, while the College of GPs has chosen not to take an official position, noting that its members share a range of opinions. 

read more
'No place' for euthanasia in NZ, doctor says as End of Life Choice bill's third reading looms

TVNZ1’s Q+A spoke to Auckland GP Dr John Cameron, who supports the bill, about the practicalities of the proposed law if it were to be voted for in the referendum.

Who would qualify for assisted dying?

The proposed law puts restrictions on who could qualify for euthanasia if it is voted into law. The person would have to be a New Zealand citizen or permanent resident over the age of 18 suffering from a terminal illness likely to end their life within six months. 

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1 NEWS online’s political reporter Anna Whyte explains what the proposed law means and what both sides of the issue are saying. Source: 1 NEWS

The person would also have to be able to make an informed decision about euthanasia and be undergoing a significant decline in physical capability and experience unbearable suffering that can’t be eased. 

A person would not be eligible to ask 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 or are of advanced age.

Read both sides of the argument here. 

Determining whether someone is within six months of dying

Cameron said when doctors make predictions about when someone would die, they would usually give a range of dates.

He said determining whether someone would die within half a year is a clinical judgement health professionals would make.

“You can say someone, within that clinical scenario, the chances of them dying within six months is greater than 80 [to] 90 per cent, and that’s probably where you would sit it,” he said.

A health professional’s colleagues and other specialists could inform predictions on times of death, Cameron said. For example, the opinion of the oncologist could play a part in determining when a cancer patient would die.

But, in the first instance, conversations about assisted dying would start in primary care, for example, a person’s GP.

He said if someone’s GP did not agree with enacting requests for assisted death, they would be required to make a referral. 

Determining whether someone was being pressured into assisted dying 

Cameron said questioning the patient about their choices could help a doctor judge whether they were being pressured into assisted dying.

“Not just what the patient answers, it’s how the patient answers it,” he said.

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The MPs appeared on TVNZ1's Q+A ahead of this year's referendum on the issue. Source: Q+A

Cameron said a safeguard of the proposed legislation was that two doctors would have to be satisfied that the person has made the decision to choose assisted dying without pressure. If there were concerns about this, a psychiatrist would need to give a third, independent opinion.

“It’s a simple life and death decision, so you err on the side of safety … part of that is your knowledge of the patient.”

For example, Cameron said he’d be uncomfortable agreeing to an assisted dying request from a new patient without more knowledge about the person’s family and situation. 

He said family would not have any say in a person’s decision-making process.

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

If the doctor decides that a person is eligible, they must seek a second opinion from an independent doctor who will assess whether a person meets all the criteria. If either doctor is unsure about a person’s ability to make an informed decision, a third opinion from a psychiatrist is required.

The actual assisted death process

After the paperwork is completed, it would be passed on to an agency which would review each case and decide whether to approve it.

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Q+A talks to Sir Michael Cullen and Vicki Walsh on why they hold their views on assisted dying. Source: Q+A

“Once that is obtained, there is a six-month window into which that agreement can be enacted,” Cameron said.

“At any point in that time, the person that has requested assisted dying can say no.”

But, he said there was a gap in the proposed legislation about making it compulsory for medical practitioners to be upskilled in carrying out assisting dying. He said doctors were not trained to kill people.

“You have to do it painlessly, with dignity, calmly, in the most compassionate and healthy way.”

He said the act outlined a number of options: the person asking for assisted dying, out of their own volition, can take a drug orally or initiate an injection. Alternatively, a medical or nurse practitioner can administer medication orally or through an IV.

For more information on the referendum, go to https://www.referendums.govt.nz/endoflifechoice/index.html

* This story was updated with extra details on Monday, 14 September 2020