Dr. Kristin Good:

Tn koutou katoa, I am the chief clinical adviser at the Ministry of Health in New Zealand. I also hold the statutory role of Registrar (assisted dying) under the End of Life Choice Act. The Ministry was responsible for the implementation of the End of Life Choice Act and has ongoing responsibility for its regulation and monitoring. I have been involved since the early implementation phase. I thank the committee for the invitation to contribute to this discussion.

Following the referendum that was held at the same time as the 2020 general election, when 65.1% of the voting public voted “Yes”, the Ministry had one year to implement the Act, which came into force on 7 November 2021. The Act provides for strict eligibility criteria; specific eligibility exclusions; a heavy reliance on process; oversight by three statutory committees or roles; and assessments of competence and coercion throughout the process. These offer important protections for people at a highly vulnerable time in their lives. Assisted dying is an emotional and polarising topic. Implementation required sensitivity and consideration, with particular attention to the welfare of vulnerable groups.

I will focus on some of the key aspects of the implementation. First, broad stakeholder engagement was key. The attitude across the various groups varied from excitement, to interest, to concern, to opposition, to the hard-to-manage disengagement. Across the heath sector every group needed to at least decide their position on assisted dying, implement policies to support that position and upskill staff. There was a lot to do to be ready for the first person who raised the topic, so we needed broad engagement and buy-in. We actively included those opposed to the Act and those who represented vulnerable groups, such as disability activists and Maori and included them on our advisory groups receiving invaluable contributions about operationalising the Act and particularly on safeguards and equity considerations.

The second topic I will highlight relates to the workforce. One of our chief concerns was whether we would even have a workforce to deliver the service, because we knew there was low support and high levels of opposition to the Act in medical professions and their professional bodies. We were also aware of high early attrition of assisted dying practitioners in other jurisdictions, often after their first administration of medication. Practitioners were stretched and exhausted by Covid-19. To support the workforce and ensure we had staff to deliver the service from day 1, we delivered interactive webinars, educational sessions, training, resources, and guidance and included practitioners in consultation on key aspects of implementation, including funding. Layers of accessible support were also put in place for assisted dying practitioners from the day the Act came into force.

We also looked at the safeguards. There was concern among the public and health professionals about how safe this was going to be. The safeguards were enhanced to complement those already in the Act. Recently described as a race to be the safest and the toughest, safeguards are essential to keep people and practitioners safe.

There is some element of practitioner intolerance in having to function within the legal constraints of the Act which are actually keeping everyone safe because health practitioners are used to a freedom they normally enjoy and it is being curtailed, for obvious reasons.

Governance and quality assurance systems were established and were vital to building trust and confidence. The third thing was accessible mechanisms for feedback and complaints. As David Seymour, MP, mentioned, the level of complaints is low. This is particularly notable for a new service and one that was under such high levels of scrutiny from day one. The complaints have mainly been about the impact of conscientious objection on people trying to access the service. We commissioned a post-implementation review after one year of service. The feedback was that a robust and trusted service foundation had been developed. The service had operated smoothly and feedback from practitioners, people accessing the service and their families has been overwhelmingly positive. The Act is working well.