Assisted Dying Service activity report: 7 November 2021 - 30 September 2022 – Health New Zealand

Overview of assisted dying applications

Figure One gives an overview of the pathway from initial application to an assisted death. Please note, we have made some changes of the diagram in this quarterly report so that the assisted dying process is clearer and the data is more functional.

Between 7 November 2021 and 30 September 2022, there were 596 applications made for assisted dying. As of 30 September:

294 applications were eligibility confirmed. 214 people¹ of the 294 applications had an assisted death, and the remainders are those who:
- withdrew their application; or
- died of their underlying conditions before their scheduled assisted death; or
- were waiting for their scheduled assisted death at the time the data was extracted.
120 applications had been assessed as ineligible for assisted dying
68 applications are still in the assessment phase
259 applications did not continue the process (due to being ineligible, withdrawing or dying of underlying conditions)

Notes:
1. People who made multiple applications are only counted once for assisted death.
2. Applicants may withdraw their applications or die of their underlying conditions at any stage of their application. Therefore, a sum of the above numbers may be greater than the total number of applications.

Figure One: Overview of applications received as at 30 June 2022- Text description

Diagram shows an overview of how the applications received up until 30 June 2022 have progressed through the assisted dying service pathway

400 people applied for assisted dying

363 first assessments were completed by attending medical practitioners

270 second, independent, opinions were completed by independent medical practitioners

3 psychiatrist opinions have been completed

101 of the 400 applications are still in process

57 people are still in the assessment phase and 44 have completed assessment and had eligibility confirmed

153 of the 400 applications ended prior to assisted death

68 people were not eligible, 23 withdrew their application and 62 died of natural causes

143 of the 400 people that applied have had an assisted death

Assisted dying applications started by month

Figure Two shows the number of applications started by month, noting that November 2021 was not a full month. An application is defined as started when the first form (the Advice and Request form) is received by the Secretariat. Please be aware, this does not count people who:

contact the Secretariat with general queries
died of an underlying condition before making a formal application
were unable to be contacted
changed their minds before filling the Advice and Request form
screened out by the Secretariat before the Advice and Request form

Figure Two: Bar graph showing applications started by month 7 November 2021 – 30 September 2022

Figure Two: Applications started by month 7 November 2021 – 30 September 2022

Demographics of applicants

Table One shows the demographic breakdown of applicants by ethnic group, gender, age group, diagnosis and whether they are receiving palliative care or not. The assisted dying service is relatively new, and numbers are small. It is expected that the percentage breakdowns will change over time.

As at 30 September:

78.8% of applicants are NZ European/Pākehā
4.8% of applicants are Māori
56.9% are women
74.8% are aged 65 years or older
65.6% have a cancer diagnosis
77.9% were receiving palliative care at the time of application.

Table One: Demographics of people that have applied for assisted dying

Demographic breakdown		Number of people³	% of applicants
Ethnic group¹	Māori	29	4.8
	Pacific	3	0.5
	Asian	11	1.8
	NZ European/Pākehā	476	78.8
	Other ethnic groups	85	14.1
Gender	Female	339	56.9
	Male	257	43.1
	Gender diverse	0	0.0
Age group	18-44 years	14	2.3
	45-64 years	136	22.8
	65-84 years	334	56.0
	85+ years	112	18.8
Diagnosis category	Cancer	391	65.6
	Neurological condition	56	9.4
	Other diagnosis	54	9.1
	Diagnosis not known²	95	15.9
Receiving palliative care at time of application?	Yes	464	77.9
	No	128	21.5
	Not stated	4	0.7
Total		596

Notes:
1. Total ethnicity has been used. This means that people with more than one ethnicity are counted against each ethnicity they identify with.
2. ‘Diagnosis not known’ includes people that applied but have not yet had their first assessment with their Attending Medical Practitioner as well as those that withdrew, died before this assessment was completed, or were ineligible due to not having a terminal illness.
3. People are counted multiple times if they made application more than once.

Assisted deaths by location

As at 30 September 2022, 214 people had an assisted death. Assisted deaths can take place at the person’s home or in the community. The breakdown by location is:

174 (or 81.3%) at the person’s home or another private residence
17 (or 7.9%) in aged care facility
14 (or 6.5%) in public hospital¹
9 (or 4.2%) in a hospice facility.

Figure Three: Bar graph showing assisted deaths by location

Figure Three: Assisted deaths by location

Notes:
1. “Public hospital” is used to replace “district health board facility” in the report, as there are no more District Health Boards in New Zealand from 1 July 2022.

Assisted deaths by month

Figure Four shows the number of assisted deaths by the month of the death.

Assisted deaths are required to be reported not more than 14 days after the date of death. Data for the period reported after the quarterly report cut-off date will show in the following quarterly report.

Figure Four: Bar graph showing assisted deaths by month 7 November 2021 – 30 September 2022

Figure Four: Assisted deaths by month 7 November 2021 – 30 September 2022

People assessed as not eligible

There are strict eligibility criteria for an assisted death. As at 30 September, 120 people had been assessed as ineligible for assisted dying.

A person may be found ineligible for more than one reason. The total number of reasons is greater than the total number of people assessed as ineligible.

Table Two: Applications assessed as ineligible by reason and assessing practitioner

Number of people	% of those not eligible
Reason ineligible (which criteria from the Act not met)	Not aged 18 years or over	0	0.0
	Not a New Zealand Citizen or permanent resident	5	2.7
	Not experiencing unbearable suffering unable to be relieved in a tolerable manner	44	23.5
	Not in an advanced state of irreversible decline in physical capability	44	23.5
	Does not suffer from a terminal illness that is likely to end their life within six months	66	35.34
	Not competent to make an informed decision about assisted dying	28	15.0
Which practitioner	Attending medical practitioner (AMP)	92	76.7
	Independent medical practitioner (IMP)	26	21.7
	Registrar	2	1.7
	Psychiatrist	0	0.0
Total people assessed as ineligible		120

Figure Five shows the number of applications assessed as ineligible by the month that the application was started.

Figure Five: Bar graph showing applications assessed as ineligible by month 7 November 2021 – 30 September 2022 — Figure Five: Applications assessed as ineligible by month 7 November 2021 – 30 September 2022

Figure Five: Applications assessed as ineligible by month 7 November 2021 – 30 September 2022

SCENZ Group practitioner lists

Table Three shows the distribution of health practitioners registered on the SCENZ Group lists by the DHB region of their usual working location and the role(s) for which they are available.

Figures below three have been suppressed for privacy reasons and are replaced with an ‘S’ in the table.

The SCENZ Group lists are dynamic and will fluctuate over time as new practitioners sign up and existing practitioners come off the lists.

Medical practitioners can be on the SCENZ list for more than one role, depending on their scope of practice (attending medical practitioner, independent medical practitioner, psychiatrist). The total number for each role will be greater than the number of unique practitioners.

The table groups practitioners by the region of their usual working location. Many practitioners are willing to travel to provide assisted dying services. Funding for travel is covered by the Ministry.

Health practitioners providing services as an attending medical practitioner (AMP) or attending nurse practitioner (ANP) do not have to be on a SCENZ Group list. For example, there are 38 general practitioners who act as the AMP for their own patients only and are not register on the SCENZ Group AMP list.

Table Three: Count of practitioners on SCENZ Group list by role and district as at 30 September

Region	DHBs	Total unique practitioners	Attending medical practitioner	Independent medical practitioner	Psychiatrist	Nurse practitioner
Northern	Northland	40	26	24	3	6
	Waitematā
	Auckland
	Counties Manukau
Midlands	Waikato	23	15	17	S	S
	Lakes
	Bay of Plenty
	Tairawhiti
	Taranaki
Central	Hawke's Bay	27	23	16	S	S
	Whanganui
	MidCentral
	Wairarapa
	Hutt Valley
	Capital & Coast
Southern	Nelson Marlborough	42	28	24	5	S
	West Coast
	Canterbury
	South Canterbury
	Southern
	Total	132	92	81	11	11

Text description

Diagram shows an overview of how the applications received up until 30 September 2022 have progressed through the assisted dying service pathway.

596 applications for assisted dying have been received.

553 first assessments were completed by attending medical practitioners.

413 second, independent, opinions were completed by independent medical practitioners.

4 psychiatrist opinions have been completed.

294 of the 596 applications had eligibility confirmed.

259 of the 596 applications ended prior to assisted death.

120 people were not eligible, 31 withdrew their application and 108 died of underlying conditions.

214 people that applied have had an assisted death.

Note
1. S = supressed data.
2. One practitioner could have multiple roles. So, the total number of unique practitioners may be different to the total number of AMPs, IMPs, Psychiatrists and Nurse Practitioners.