Attitudes of New Zealand doctors and nurses towards legalising assisted dying – Report to New Zealand medical and nursing associations

Abstract

Key findings are as follows:  Consistent with other recent New Zealand studies, 37% of doctors responding to the survey “strongly” or “mostly” agreed that AD should be legalised in New Zealand, assuming provision of appropriate guidelines and protocols. In contrast, two thirds of nurses agreed that AD should be legalised here.  Respondents’ main reasons for wanting legal AD revolved mainly around four factors: a belief in people’s right to autonomous decision-making at the end of their life, irrespective of health practitioners’ beliefs; philosophical beliefs about personal dignity and a perceived right for people to avoid unnecessary pain and suffering at end of life; respondents’ professional or personal experiences of witnessing severe suffering at end of life; and a perceived failure of some health practitioners to acknowledge medical futility, resulting in suffering through prolonging people’s lives.  Respondents’ main reasons for not wanting AD legalised mostly concerned: a belief that undertaking AD functions was not a proper role for health practitioners; a belief that vulnerable people will be pressured to end their lives prematurely; respondents’ professional experience with and/or belief in the adequacy of good palliative care; and moral/ethical (non-religious) objections to legal AD. 2  The main influences on both doctors’ and nurses’ views about legalising AD related to their personal philosophies and ethical beliefs, clinical experiences and personal experiences. Respondents’ religious beliefs and the stance of their professional associations were of notably less importance. Just over half of doctors and two thirds of nurses had been influenced by research evidence.  Doctors’ and nurses’1 approval of making legal AD available was not limited to people with a terminal illness, but extended to people with multiple aging-related comorbidities and to people in a persistent vegetative state or suffering from dementia where the person had made a valid advance directive.  Nearly one in 10 doctors responding to the question about actual provision of AD had at some time either provided or administered a lethal dose of medication to help someone to have a hastened death, and nearly one percent had done so “several” or “many times”. 2 This finding, supported by a NZ Doctor survey in July 2015, shows that the number of doctors either providing AD or being willing to report doing so has doubled in the past decade. Some nurses had also provided AD.  Seventy-five percent to 90% of doctors and nurses reported feeling comfortable considering AD for themselves and/or supporting it for a family member.  Two thirds of doctors were willing to write a prescription for a lethal dose where a patient had met the eligibility requirements, and 43% of nurses were willing to undertake that role if it were legally authorised for their profession. Over half of doctors and two thirds of nurses (if so authorised) were willing to administer AD via either injection or intravenous line. Large percentages (86-96%) of both doctors and nurses were willing to discuss AD with patients, provide information about AD to patients and refer them to another practitioner if needed. A majority of both doctors (63%) and nurses (76%) were willing to attend an assisted death by self-administered ingestion  The most common reasons why both doctors and nurses might be deterred from participating in legal AD were a lack of authorised guidelines for undertaking AD safely and competently, a lack of training and skills and a lack of support from their profession. Personal philosophical objection to AD was the least common reason why doctors and nurses might be deterred from taking part in AD.  Large majorities of both doctors and nurses voiced a need for a range of protections to support their participation in legal AD, in particular: training for AD skills; authorised guidelines from their regulating bodies; immunities from prosecution; the option of conscientious refusal and referring patients to another professional; mentoring; and a statutory body to check compliance by health practitioners with the legal requirements. Note, while no survey can claim to be entirely representative of the population, the results from this research appear to show that there is a significant cohort of doctors and nurses in New Zealand who support legalising AD and potentially sufficient to ensure that there will be enough health practitioners available for that eventuality. It is noteworthy to see the emphasis in respondents’ answers below on wanting strong accountability processes and professional supports for the safe provision of AD.