Image: Tina Tiller
Image: Tina Tiller

SocietyNovember 11, 2021

The End of Life Choice Act is now in effect. Here’s what you need to know

Guest writer
Image: Tina Tiller
Image: Tina Tiller

Following last year’s referendum, terminally ill New Zealanders now have the right to end their own lives – but only under strict conditions. Lawyer Holly Hedley of Buddle Findlay explains the rules.

The End of Life Choice Act came into effect on November 7, meaning that terminally ill New Zealanders who meet the legal criteria can choose to end their lives with medical assistance.

The act has two key parts. The first is to give a person who has a terminal illness, and who meets certain other criteria, the option of lawfully requesting medical assistance to end their life. The second provides the process for medical practitioners to help people exercise that option. The legal process is detailed and it must be followed to the letter before a person can legally access assisted dying.

As with any new legislation, the real test for the act will be in its practical application. So, what are some of the practical questions you might need to know about the assisted dying process? 

Who is eligible?

There are clear eligibility criteria in the act. From a medical perspective, the three key criteria are that a person must be suffering from a terminal illness, one that is likely to end their life within six months; be in an advanced state of irreversible decline in their physical capability; and, be experiencing unbearable suffering that cannot be relieved in a manner they consider tolerable. 

Importantly, the person must also be competent (of sound mind) to make their own decision about assisted dying. No one else, not even a formally appointed enduring power of attorney or welfare guardian, can make that choice for them.

Contrary to some people’s concerns about the act, the services are not available to children. The person must be at least 18 years old and, in order to prevent “death tourism”, the person must also be a New Zealand citizen or permanent resident. 

The role of the medical practitioner

If a person wishes to know more about assisted dying, they must start the conversation with their medical practitioner. The act in fact expressly prevents any health practitioner from initiating the conversation, so the onus is on the patient to ask first. This is unusual in health care, and it will take some getting used to, as usually practitioners would be proactive in offering up options and information.

A “medical practitioner” means any properly registered doctor, but for most people the best starting point will be their GP or specialist doctor.

Importantly though, not all doctors have to be involved with assisting a person to die. In fact, any health practitioner who has a conscientious objection can excuse themselves from being involved. However, there are requirements on all doctors who are asked about assisted dying to let the person know if they have a conscientious objection. They must also inform them about their ability to access a different practitioner through the national Support and Consultation for End of Life New Zealand (Scenz) group.

There will also be occasions where a person’s usual doctor might not have a conscientious objection, but are nonetheless not appropriately trained to provide the services. In practice, all doctors who are providing assisted dying services will need to have completed the relevant Ministry of Health training and ensure that they act within their scope of their practice and expertise. This means that some doctors may have to refer elsewhere to ensure the person receives the best and appropriate services.

What about nurses or other health professionals?

The act requires doctors to work through the assisted dying process (the phrase used in the act is “attending medical practitioner”). Other health professionals may also be involved in a supportive or information giving capacity, but the formal process must be completed by a doctor. At the end of the process a specially qualified “attending nurse practitioner” can also assist the doctor with the administration of the medication and some other steps. 

What if a family member disagrees or has concerns?

The act is clear that the decision about assisted death is for the person themselves to make, and this approach fits with the general patient-doctor confidentiality and autonomy principles that exist within our current law. However, any doctor who is working through this process with a patient is required to “encourage the person to discuss their wish with others such as family, friends, and counsellors”. Furthermore, if there is any reasonable suspicion that the person is not making their own choice, the process must be stopped.

There are also statutory bodies that have been specifically designed to oversee the act and to deal with complaints. The Ministry of Health has recently published an 0800 number and email address which members of the public can contact if they have concerns about an assisted dying process. Family members can, of course, also raise concerns directly with the health team involved or with the health and disability commissioner. 

What other safeguards are there?

The detailed process within the act includes inbuilt safeguards. A key one is that there must be at least two medical practitioners involved in assessing a person’s eligibility: the first being the attending medical practitioner who is approached by the patient; and then the second being an independent medical practitioner (who will be accessed through the national Scenz group). If there are any concerns about the person’s competence, then a psychiatrist must also be involved.

As explained above, the act also requires the process to be stopped if, at any point, there are reasonable grounds to suspect that the person is not making their own choice (eg if there are concerns that the person is subject to pressure).

When and where will this all happen?

Assisted dying services are available and legal right now. The idea is that most assisted dying services will be provided within the community, usually in a person’s own home if possible. Hospitals are not going to be the best place to have these conversations and provide these services, but they will be there if need be. 

Will we read about cases of assisted death in the news?

There are publication restrictions in section 36 of the act, which mean that specific details about a person’s assisted death cannot be published (including details about the method by which medication was administered, place where it occurred and the name of the person who administered the medication or their employer). Family and/or loved ones can of course still talk about the death in a general way. However, publication of those particular details is not allowed.  

End of Life Choice Act and life insurance

A lot of questions have been raised about what the act might mean for life insurance. This is because life insurance policies can sometimes have exclusions if a person dies through suicide or other intentional self-injury. The act addresses these concerns. It provides that a person who dies through assisted dying is – for the purposes of any life insurance contract – taken to have died from the terminal illness suffered, eg as if assisted dying had not been provided. 

What’s next?

More Reading

Looking ahead, special attention needs to be given to ensuring fair and equal access. This is an issue that New Zealand’s health and disability sector has been grappling with for some time, particularly given the challenges faced in more rural areas and within a stretched workforce. 

The Ministry of Health Manatū Hauora is constantly updating its information about assisted dying services, and it has published plenty of guidance for the public and practitioners alike. If you or a loved one are considering assisted dying services, then you can review this information and then begin the conversation with a doctor you trust. 

This article is intended as general information only and is not legal advice. 

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Image: Tina Tiller
Image: Tina Tiller

InternetNovember 11, 2021

Considering van life? It mostly sucks

Contributing writer
Image: Tina Tiller
Image: Tina Tiller

On Instagram, living and working from a van seems idyllic and whimsical, so Josie Adams gave it a whirl. She reports on the unglamorous reality for IRL. 

I’m one of the lucky Aucklanders who got locked down outside the city when delta first made its unwelcome debut. I was in Wellington on a little holiday when the prime minister announced the latest lockdown, and faced with the choice of going back to infection central (Auckland) or becoming homeless, I chose to stay in the capital.

From there, I decided to roam the lower North Island, remote working from anywhere with wifi and a car park. It was that or find a flat in Wellington, which has become such a squalid rental dystopia that living in a van retained more of my dignity. 

Social media made it seem that way, anyway. On Instagram, fashion entrepreneur Brittany Cosgrove makes escaping both the Wellington rental market and her ex-boyfriend for a life on the road seem adventurous and full of laughs. Inspired, I saw myself waking up at a new beach every day, and taking a dip before brewing my artisan coffee. I’d send emails from my phone and dictate articles to Otter as I drove through the picturesque mountains.

 

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So I rented a converted Toyota Estima for $23 per day, plus insurance. I reckon I’m not the only one who’ll be exploring this option, either: there’s a strong desire to escape the aforementioned rental hell in our major cities, and despite better public transport options slowly materialising, New Zealanders remain dedicated to their cars. We have the fourth-highest per capita car ownership in the world, and the amount of driving we do is only on the up.

Our homes and workplaces have already begun to meld together. I see vehicle living as the next stage in the total reduction of our personal spheres. My car, my home, my castle – and my office. To prepare you for the future, I’d like to share my experience living and working in a van, warts and all. 

The work day

My dormant hunter-gatherer genes were activated in the van. I rose with the sun, and slept as soon as the temperature dropped. As well as a six-hour sleep at night, I did a two-hour spell of staring into the sun during the day. I needed to break up the driving, working and eating in the van with a dose of what yogis call “mindfulness” and I call “shark naps”: eyes open, brain dead, windows down and the ether rushing past my gills. 

Our sleep cycles and our work days aren’t natural. We all know this, deep down, but the road makes it clear. I would wake up around 7am, drive a couple of hours to a cafe, and get to work. After a few hours, I got back in the van and drove again, to whatever public library called to me in the distance. Sometimes I took my fully-charged devices to some weird freedom camping site and watched all the episodes of Dynasty I downloaded. Other times I pulled up to a Mitre 10 and had Zoom meetings in the car park. I got my eight hours of work in, in whatever pattern the road threw at me.

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The night was my own, but it also belonged to everyone else in the campground. Going into freedom camping, I thought I’d see a lot more hippies with surfboards – and in Castlepoint and New Plymouth this was accurate. Mostly, though, it wasn’t. Sometimes the grounds were full of retirees with tiny dogs in expensive motorhomes. Sometimes there were cars with tarps instead of windows and a backseat full of sheepdogs. Once there was a guy on a bicycle and his very nice Staffordshire.

There was a huge range of people and dogs, is what I’m saying. They mostly kept to themselves, but due to my chronic night paranoia I would not sleep until every other van in the campground had fallen silent. New Zealanders are broadly good folk, but I did not want to be murdered by man nor dog.

Wifi

I recently found out Elon Musk’s global satellite internet network, Starlink, is not free nor even cheap. I don’t know why I expected otherwise; I guess I hoped he’d be making up for threatening unionised workers, the cybertruck debacle, or being embarrassingly devoted to terrible cryptocurrencies. Long story short, I did not have wifi in the van. Instead I conducted interviews from the Warehouse car park. Its wifi is both free and high quality, and there’s always a roomy parking space.

If you’d like to get out of the vehicle and work at an actual table, cafes are good. Pubs that open early are better. They usually have wifi, and very few customers pre-dinner. One of my favourite remote working sites is the 1852 Pub and Kitchen in Brooklyn, Wellington – it’s massive, empty until three or four, and has great wifi. They did not mind me nursing one beer for three hours. 

Josie Adams gives van life a go with, uh, mixed results. (Image: Josie Adams)

Wifi for entertainment purposes needs to be accessible outside of your work hours. While some of the expensive ($20) campgrounds claim to have wifi, it’s usually some sort of ghost network your device will connect to but never be able to access. You’re better off using a library or Warehouse to download some Netflix shows.

Podcasts don’t use as much bandwidth, but they are more boring. I’m sorry, I’m tired of pretending they’re good. I listened to some podcasts but it was just so I didn’t feel like I was alone in a car surrounded by the small, smelly pile to which my worldly possessions had been reduced.

The fuel

When I started my van journey, I felt empowered. I was liberated. I was a road warrior. Three days in, I found myself sleeping next to a graveyard eating a jar of peanut butter for dinner. Yes, there was technically a gas stove in the boot. No, I would not set it up so I could cook Shin Ramyun in a Taranaki downpour.

The van had water and a portable gas stove and kettle, so coffee was possible no matter where I was. Could I be bothered setting up the gas and opening the boot twice a day for a dose of the demon bean? Absolutely not. I drank van-temperature soy milk with instant stirred in. I ate roadside fruit, and also a lot of pretzel bites.

When it comes to refuelling the van rather than yourself, conventional wisdom holds. Fuel up outside the city as it’s less expensive, and get obsessive about your tyre pressure. The higher it is, the less petrol you use.

The desk

You can turn the bed in the back of your van into a rough approximation of a table and chair arrangement. However this does not appear to be possible without tearing the entire van inside out and then Tetris-ing it all back in. The end result: somehow worse for your back than just lying down.

I have conducted interviews lying down in the back of the van nestled against a bag of used baby wipes, which is great for sound quality but terrible for your posture and sense of professionalism. 

My recommendation: leave the van if you can. Even just get on the ground and work from the pavement. Get your body out of the vehicle before it fuses to the upholstery. 

Van life seems like the future of work, at least from where I’m parked – and it’s a pretty dismal one. It’s less swimming in waterfalls and more sleeping, working, and often pissing in the same two square metres. You can drive for hours every day in search of something better, but all that piss and soy milk and sheets of work still rattles around right behind you.

Of course, I was roughing it. If you’re serious about working from the road, you can just spend $250,000 on a motorhome instead.

Have you been the victim of a catfishing or online scam? Do you make your living in the gig economy? Got a great yarn about the internet? Get in touch with us at irl@thespinoff.co.nz. 

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