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Responding when a person raises assisted dying: conversation guide and handbook

It is important health professionals are prepared to respond with respect and compassion if assisted dying is raised by a person, regardless of personal views.

The conversation guide and accompanying handbook, aim to support registered health professionals to respond appropriately and respectfully if a person raises assisted dying with them.

These resources are designed to support health professionals when responding to an initial request.

They are not intended to be used to assess a person’s eligibility. It contains an overview of the assisted dying conversation guide and strategies for common scenarios.

Read the handbook for responding when a person raises assisted dying first, before using the conversation guide.

An e-learning module is available to support understanding and use of the conversation guide. Health professionals can access the e-learning module in LearnOnline. 

Assisted dying care pathways 

While not all health practitioners will provide assisted dying services, a person can raise assisted dying with any health practitioner.

It is important to ensure the person’s request is met with respect and compassion. There are also legal obligations for medical practitioners when assisted dying is raised.

There are three care pathways for assisted dying services that provide an overview of the process followed when a person raises the topic of assisted dying or chooses to access the assisted dying service.

  1. For medical practitioners who do not provide assisted dying services for reasons of conscientious objection or as they do not have the appropriate skills or experience (reasons of competency).
  2. For health practitioners (not including medical practitioners) who cannot provide assisted dying services.
  3. For medical and nurse practitioners who will provide assisted dying services.

Objectives of the care pathways

The three care pathways aim to ensure that assisted dying services are provided in a person- and whānau-centred approach, which focuses on what matters from the perspectives of the person and their whānau at each step of the process.

A person- and whānau-centred approach means that a person and their whānau are heard, information is provided in a way that is understood by a person and their whānau, and the person is empowered to self-determine. Choosing assisted dying is the person’s choice.

Health practitioners are encouraged to consider any additional support a person may need throughout these care pathways based on individual circumstances, such as for a person with a complex, disability, or social support needs.

The objectives of the care pathways include: 

  • robust accountability and safety measures 
  • timely access to appropriate information (verbal, written, accessible formats, translations)
  • equitable access and service delivery
  • continuity of care throughout the care pathway
  • consistency with health and disability system legislation and strategies, including standards of care, codes of conduct, evidenced best practice and Te Tiriti o Waitangi.

The assisted dying care pathways for health practitioners supporting information guide provides an overview of the process followed when a person raises the topic of assisted dying, or chooses to access the assisted dying service.

The three care pathway diagrams can also be downloaded and used as reference documents: 

Further information is also available in the e-learning module: Assisted dying care pathway: Overview. This e-learning module explains the process for accessing assisted dying, including the roles of different health practitioners.

Standard of care

Manatū Hauora has published the Standard of care, titled 'Te taumata manaaki: Te Te tuku i ngā rongoā mō ngā assisted dying services i Aotearoa | Standard of care: Administering assisted dying medication in New Zealand Aotearoa' (read the Standard of care in full). It outlines best practice in administering assisted dying medication to ensure safe service delivery for people and whānau. It was approved for use by the SCENZ group.

Medications

The medications to be used for assisted dying are safe and effective medicines. Use of these medications for assisted dying is what’s is referred to as an ‘off-label’ use. That means a medicine is prescribed for an indication or a patient group that is not included in the product information. Prescribing off label is very common.

A centralised pharmacy distribution approach through two hospital based pharmacies will enable medications kits to be provided on prescription directly to practitioners delivering the services across the country. 

Medical and nurse practitioners who are providing the assisted dying service will be provided with the Assisted Dying Clinical Guideline covering considerations and requirements related to medications and the administration. 

For safety reasons the detail of the medication regimes will only be provided directly to the practitioners providing the service. Details and names of the medicines will not be made publicly available due to restrictions on promotion and legislative criteria.

Assisted dying is a sensitive topic and may be difficult for some people. Please talk to your employer if you need support, including access to the Employee Assistance Programme (EAP).