He's concerned about ACT Party leader David Seymour's desire to widen the End of Life Choice Act criteria. Seymour argues the change is necessary, as many who want assisted suicide are "missing out".

Seymour says this is mainly because those people don't have a terminal illness likely to end their lives within six months.

The six-month terminal prognosis requirement prevents those with chronic conditions or disabilities from being eligible.

Betty argues broadening the eligibility criteria would not improve equitable choice for those facing end-of-life decisions.

It should not progress in light of the current palliative care climate in New Zealand, he cautions.

Nor should it happen without careful analysis.

Despite its supreme importance to New Zealand's health system, palliative care is not well catered for, says Betty.

"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.

"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.

Betty says New Zealand's 5,500 GPs, specialist GPs, trainees and rural hospital doctors often provide palliative care to their patients free of charge.

That's because there is no funding available for end-of-life care - a serious failing of the system, he says.

"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."

This, coupled with a growing workload and an increasing complexity in clinical patient needs, adds pressure to palliative care practices.

"The question becomes - why don't we have that exact same focus on palliative care," Betty says.

The Assisted Dying Service Data and Report from 7 November 2021 to 30 September 2022 says only about 80 percent of those choosing assisted suicide or euthanasia have access to palliative care.

Betty cautions against this analysis.

"It doesn't show perceptions of what is going on or the quality of care they are receiving," he says.

The data's effectiveness should be questioned when the Act is reviewed, he adds.

"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."

Source

• Scoop
• NZ Herald
• 1News

A year after coming into force, the End of Life Choice Act is working well and opponents of the law change had "melted away," Seymour says.

"The figures overwhelmingly show a law that is working. People can and do get through the process to become eligible for assisted dying, some change their mind, some are assessed as not eligible. That is what we'd expect if the law was working."

In the year since the law was passed, 214 patients have been euthanased.

In all, 596 people have applied, and 294 have been deemed eligible and 120 people were turned down because they were not eligible.

Seymour says a third of the ineligible patients were declined because they didn't meet the criteria of having a terminal illness likely to end their lives within six months.

He says he suspects "some if not many have an illness that is terminal but without a certain timeframe."

Seymour says he agreed to the six-month timeframe to gain the Green Party's support to pass the bill.

"I fear that compromise is leading to people ... missing out on having choice and control, even though their long suffering is just as real as those with a more immediate terminal condition."

His original bill would have allowed non-terminal patients with "grievous and irremediable conditions" to get access to voluntary euthanasia.

The amended law, which was voted on in a public referendum, made it explicit that applicants could not get access to assisted dying on the basis of disability or mental illness alone.

Seymour says he will argue for the euthanasia law criteria to be broadened when the law comes up for review in 2024.

He is also concerned that one in six applicants had died of underlying conditions before they were able to get an assisted death.

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

Better palliative care

While Seymour wants the law relaxed, health experts are calling for wider support for palliative care services.

Royal College of GPs says it's too early for any new legislation changes.

The College is calling for ongoing observation for the next 12 months.

The Royal College of GPs medical director, Dr Bryan Betty says he'd like more funding for palliative care services sector-wide.

"There is underfunding for hospice, there is underfunding for specialist palliative care services, and there's under-funding of palliative care to general practices which support patients who are dying."

Since December 2021, numbers seeking end-of-life treatment have risen from around 15 per month to around 20 in September 2022.

Source

• NZ Herald
• One News