Assisted Dying Service Yearly Report November 2022 to December 2023

The second Annual Service report reflects a summary of individuals’ interactions with the Assisted Dying Service between 7 November 2022 – 31 December 2023. Importantly, this year’s report includes 13 months, to align future reports with the calendar year for better comparison and an improved reporting structure. Note that some applications received during this time were ongoing at the end of the reporting period.
A more detailed report for data across the first year of service (November 2021 - November 2022) can be found on Te Whatu Ora website: Assisted Dying Service yearly report 2021/2022 (Word Version), (PDF Version).

Assisted dying involves a person experiencing unbearable suffering from a terminal illness taking or being administered medication to end their life. There are strict eligibility criteria to have an assisted death. Not everyone with a terminal illness will be eligible. New Zealanders aged 18 or over who have a terminal illness which is likely to end their life within 6 months may be able to access assisted dying.

The service involves specific steps, medical assessments, and essential safeguards. These are to ensure a person is eligible and making their decision independently, without pressure from anyone. The framework for the service and its eligibility criteria and safeguards are set out in the law, called the End of Life Choice Act 2019 (the Act). The Assisted Dying Service is overseen by the Ministry of Health | Manatū Hauora.

The information routinely collected by Health New Zealand | Te Whatu Ora is determined by the requirements outlined in the Act. This report follows the specific purpose of gathering and reviewing information as mandated within the Act. The content included within this report is presented in the interest of both public and academic review.

Within the document, we use the acronyms AMP (referring to attending medical practitioner) and IMP (referring to independent medical practitioner). These practitioners perform the medical assessments to determine eligibility. For more information relating to practitioner roles, please refer to our website or the End of Life Choice Act 2019.

Certain low numbers relating to applications within the year review are enclosed in full. The decision to disclose this information is made in specific instances with explicit consideration of the protection of privacy of those involved. To protect the privacy of the patients, whanau, and medical practitioners involved with the service, some information has been suppressed.

Between 7 November 2022 and 31 December 2023, Health NZ received 1015 formal applications for assisted dying. Of these 1015 applications 978 have progressed from initial application to AMP assessment. Those 37 who did not progress either:

• withdrew their application
• died before the AMP assessment was formally initiated
• were found to be ineligible prior to formal initiation of the AMP assessment
• the application was still open (had not yet progressed to assessment) during the period set out in this report.

Over this reporting period, AMPs completed 1041 assessments and IMPs completed 768 assessments. These are inclusive of assessments completed for open applications carried over from previous period. Of those assessed over the year, 624  applications were confirmed as eligible and 430 assisted deaths occurred. During this period, 584 applications did not proceed to an assisted death following assessment due to:

• the applicant withdrawing their application
• the applicant being found ineligible or not competent to give consent at or following assessment
• the applicant dying as a result of underlying conditions
• the application being found to not comply with the Act at final review.

Figure 1 below outlines the number of applications initiated per month during this period. Note that November 2022 in Figure 1 reflect a partial month from 7 November 2022.

Figure 1: New applications received by month

Notes:

1. Total ethnicity has been used. This means that individuals reporting more than one ethnicity are included within each category to which they identify. In the current report, individual identification as ‘European’ has been included within the ‘Other’ category, distinct from NZ European/Pākehā
2. Total diagnosis has been used. This means that individuals presenting with multiple diagnoses are included within each applicable diagnostic category.
3. Repeat applications are included as unique instances. This means that in cases where an individual submits multiple applications during this period, their information is recorded in the demographic data each time.
4. ‘Diagnosis not known’ includes individuals who have applied but have not yet completed their first assessment with their AMP, as well as those who have withdrawn before assessment, died before this assessment was completed, or were ineligible due to not having a terminal illness.

Note: The number of assessments in Table 3 are inclusive of applications that were open and carried over from the previous period.

Note:Total reasons for ineligibility have been applied. This means that individuals may be found to be ineligible across multiple criteria, and each observed reason is included in the report.

Requested competence assessment

In some situations, a person will also be seen by a psychiatrist. This will happen if the AMP and IMP both think the person is eligible, but one or both have concerns about whether the person is competent to make an informed decision. 

During the period described, only 12 individuals were referred for a competence assessment. All but two were determined to be competent to consent, while the remaining individual died in process before a decision had been completed.

Number of re-applications

94 individuals made more than one application for an assisted death during the reporting period. There are several reasons why an individual might make more than one request. This includes, but is not limited to:

• the applicant being assessed as ineligible at the time of the first application, and choosing to reapply
• the applicant withdrawing their original request and then deciding to reapply
• an observed change in the applicant’s individual circumstances which affects their eligibility (e.g., a change in prognosis).

No individual has made more than one reapplication during this reporting period.

Number of assisted deaths

Between 7 November 2022 and 31 December 2023, 430 people had an assisted death.

The figure below outlines the number of applications initiated, eligible applications following assessment (referred to in Table 3), and assisted deaths by month. Note that November 2022 in Figure 2 reflects a partial month (from 7 November 2022 to 30 November 2022).

Figure 2: Application and eligibility of assisted deaths

Location of assisted deaths

Assisted deaths can take place at the person’s home, in hospital, or in the community. The summary by location for this period of review is:

• 341 (or 80%) at the person’s home or another private property
• 35 (or 8%) in a public hospital
• 41 (or 9%) in an aged care facility
• 10 (or 2%) in a hospice facility.
• 3 (or 1%) in Other community facility

SCENZ Group practitioner lists 

The Support and Consultation for End of Life in New Zealand group (SCENZ group) is responsible for maintaining the list of medical practitioners and Psychiatrists involved in providing assisted dying services. As of the date of review, there were 127 practitioners registered as members on the SCENZ list.

Medical practitioners can be on the SCENZ list for more than one role, depending on their scope of practice (AMP, IMP, Psychiatrist). The SCENZ group also holds a list of willing Nurse Practitioners. For more information about the SCENZ group and practitioner roles, please refer to our website.

Table 6 outlines the number of each role on the SCENZ list, by region. Due to low numbers, precise numbers by region of Nurse Practitioners (total = 13) and Psychiatrists (total = 10) are suppressed.

More than half of all practitioners (AMP, IMP, Nurse Practitioners, and Psychiatrists) have indicated that they are willing to travel to facilitate access to the service.

Notes

*In the case of AMP and IMP, practitioners may choose to perform either, or both, of the roles. In this reporting, ‘Both AMP and IMP’ reflects a practitioner who performs both roles. Practitioners performing both roles are also represented within the respective totals included above (i.e., AMP 88; IMP 80).

A growing number of health practitioners have chosen to provide services as an AMP for their own patients without registering to be included as a SCENZ member. A portion of these health practitioners have subsequently chosen to join the SCENZ group, and to make themselves available to additional patients.