End-of-Life Care Act: challenges and opportunities

Abstract

In October 2020, New Zealanders strongly supported adoption of the End-of-Life Care Act (EoLCA). From 7 November 2021, people with unbearable suffering from a terminal illness will be able to legally seek medical assistance to end their lives. Despite being the result of a binding referendum there remain uncertainties regarding how the Act will be implemented and the professional obligations of healthcare professionals involved.

For example, it remains to be determined: • which doctors can legally discuss euthanasia with patients, and indeed which doctors can prescribe and administer the lethal dose (EoLCA refers only to the requirement for practising certificates) • specific criteria that will trigger enforcement of the Act • guidelines regarding conscientious objection by healthcare professionals and prevention of coercion from family and carers • how professional colleges will educate, guide, and support their members

Apart from these practical and logistical considerations, medical practitioners now face the psychological challenge of adjusting to the new law, its implications for our professional identity and, crucially, doctor-patient relationships. Some clinicians will regard the Act as providing an important and rewarding option to facilitate patient dignity and autonomy. Other doctors with a philosophical/conscientious objection to euthanasia, while able to opt out from direct involvement in the process, are nonetheless obliged to enable motivated patients and their families to obtain information and access to medically-assisted dying. This is likely to be a particular challenge for palliative care specialists and hospices, given their traditional opposition to euthanasia.

Amidst these challenges also exist other opportunities for enhanced end-of-life care. Chief among these is the recent clinical rediscovery of psychedelic and related medicines. Accumulating evidence indicates these may enhance existing palliative interventions and offer important alternatives to conventional therapies. Reference will be made to a New Zealand trial of methylenedioxymethamphetamine (MDMA) in treatment-resistant anxiety and depression in terminal illness.