Talks of expanding the eligibility criteria in assisted suicide and euthanasia legislation have been met with strong caution by Royal College of GPs medical director Dr Bryan Betty.

The practice of assisted suicide and euthanasia has been happening for little over a year in New Zealand, and already some proponents are calling for changes to the criteria saying many are “missing out”. The main criteria under fire is the 6 month terminal prognosis requirement, which prevents those with only chronic conditions or disabilities from being eligible.

But Dr Betty says broadening the eligibility criteria would not improve equitable choice to those facing end of life decisions. He is adamant that expansion of the End of Life Choice Act should not progress in light of the current palliative care climate in New Zealand, and not without careful analysis.

He says palliative care is the most important part of the country’s health care system, but its current situation is dire.

“There's no strategic plan as to what is going to happen with palliative care, there's fragmented services, lack of funding… the list goes on. It’s not a situation we can allow as a first-world, caring society.”

The contrast and imbalance of palliative care vs assisted suicide and euthanasia is sizeable and cause for concern, he says.

“We have one part of the system fully-funded and overseen in an apparently coherent way by the Ministry of Health (assisted suicide and euthanasia), and the other sector that doesn’t even have a strategic plan in place, that is inequitably funded, and has no coherent overview of how to develop the service,” Dr Betty says.

“Why don’t we have the exact focus on palliative care, so anyone making the biggest decision of life can make an equitable, informed choice?”

It’s remiss of the Government, politicians and the Ministry of Health, he says.

“There's a team of 7 or 8 that work on assisted dying (assisted suicide and euthanasia) in the ministry, but not one who has a focus on palliative care within the organisation.”

The Royal College of GPs includes more than 5,500 GPs, specialist GPs, trainee GPS, and rural hospital doctors who practise a range of different modalities from 1000 practices across the country.

Dr Betty says these doctors are often providing palliative care to their patients pro bono because there is no funding available for end of life care, and it’s a serious failing of the system.

“Palliative care is so dependent on local funding which is traditionally done by DHBs, but there’s a total lack of funding, resourcing and a national approach,” he says.

This, coupled with a growing workload and an increasing complexity in clinical patient needs, is all pressure that adds to palliative care practices, once again raising doubt about whether there really is choice for everyone making end of life decisions.

“The question becomes why don't we have that exact same focus on palliative care so that anyone making the biggest decision of life can make an equitable informed choice so they will get quality best practice care,” Dr Betty says.

Regardless of the state of end of life care, ACT leader and End of Life Choice Act designer David Seymour is still pushing for a broadening of eligibility criteria.

"It's excluding people with long-term conditions, and that means a lot of suffering that may not be necessary," Seymour says.

Dr Betty cautions now is not the time to consider any changes. Closely monitoring the current practice is what is needed.

“We need to check things like the numbers, that there’s no unintended consequences in equality of what’s occurring; it’s really important to understand how we're operating and what's going on. The monitoring function is a critical aspect so we can make informed decisions as to where we should go from here.

“If the perception is ‘I don’t get access or care with palliative’, we have a problem with the system. People have to have informed equitable choice in the way they choose to work through a terminal illness.”

According to the most recent Assisted Dying Service Data and Report released by the registrar from 7 November to 30 September 2022, around 80 percent of those choosing assisted suicide or euthanasia have access to palliative care. But Dr Betty says a broad yes/no question offered lacks useful quality for analysis.

“There’s a myriad of things that underpin that statement. It doesn’t show perceptions of what is going on, or the quality of care they are receiving. This is a question (how effective is that type of data) should be asked when the act is reviewed,” he says.

“The quality of palliative care provision is concerning. Currently there is an array of palliative care offered across the country but it varies strongly depending on what geographical area a patient lives in, and how much responsibility a GP agrees to take on.

“The most common set up is a mixed-model, with some input from specialised services but prescribed oversight by a GP, especially in rural or high-needs areas. In some situations a GP does the whole thing,” Dr Betty says.

“GPs are paid via the normal service fee by the patient, and in some cases you can put together a plan and there may be a small funding provision. But in some high needs patients can’t afford it and often we do it for free as there’s no other way,” he says.

“Everyone is affected by death and dying. That is part of health. Good dying and having equitable choice is a fundamental part of the healthcare system we set up. It has to be given space and focus at this point.”

#DefendNZ continues to call for improvements to be made to the flawed End of Life Choice Act. There are clearly some very troubling safety, transparency and accountability errors which need urgent attention.

The only way to hope for any improvement is for amendments, like our Six to Fix, to be made to the Act so that the harmful impact of this legislation on vulnerable New Zealanders is lessened. We urge members of the public to sign the petition and add their voice to the ever-growing list of concerned citizens.

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