Workplace policies needed on end of life law

September 1, 2021

Nurses need to think about what their roles will be under the End of Life Choice Act and seek the support and guidance they will need.

Michelle McGrath
Michelle McGrath

From November 7, people can access assisted dying in Aotearoa New Zealand. The Ministry of Health (MoH) is working on guidelines for nurses and kaiāwhina/health-care assistants. But with the service becoming available soon, it is now nurses who must ask themselves if they are happy to take part and what guidance, support and training they need to keep themselves professionally safe. Conversations must be had with colleagues and employers about what nurses will need to ensure patients’ rights are upheld under the End of Life Choice Act 2019.1

Nurses are the members of the health team consistently involved in patient care. Although the role of the nurse is not part of the act (except for nurse practitioners (NPs) – more about that later), nurses will continue to provide care and support for patients and their whānau accessing this service. This may involve providing care for the patient up to and at the time they have chosen to die, and providing support for whānau after death. This role can be deeply affecting for the nurses involved and require a network of support to be put around them.2

It is important for nurses to be clear whether they have a conscientious objection to taking part in an assisted dying service, or if they are happy to be part of it. Nurses are not obliged to take part if they have a strongly held belief it is wrong.

No matter what the nurse’s personal beliefs, patients must still receive continuity of care and a clear pathway to accessing assisted dying. For nurses who have a conscientious objection and those who do not, there must be workplace policies to provide guidance in communicating with patients about assisted dying.

Knowing how to have conversations about assisted dying is essential as, under the act, assisted dying must not be initiated by the health practitioner. Of the health team, nurses most often have the rapport and relationships with patients that facilitate conversations about death and dying. Patients may talk about wanting to “end it all”, or say “put me out of my misery” rather than asking specifically about assisted dying. The nurse must ascertain if the patient seeks assisted dying without initiating that discussion.2

The service is not available until November 7. Patients can be referred to the Ministry of Health’s community information sheet,1 but having local policies would guide nurses in navigating such conversations.

Some organisations, such as Hospice New Zealand and some aged-care providers, have chosen not to provide assisted dying as part of their service. Such employers must have clear pathways for patients to access this service externally. Having an understanding of how nurses can maintain continuity of care for the patient if the patient is also accessing assisted dying from another provider is essential. Nurses, who already work under very stressful conditions due to short staffing, must have the resources available to guide them to support the patient’s choice.

The role of the NP in assisted dying is contentious. NPs have worked as autonomous practitioners since 2016, and yet under the act are to work under instruction from medical practitioners. The act says NPs may prescribe the medication involved. However, this medication, under section 29, is unapproved for NPs to prescribe. This undermines the NP scope of practice.

While waiting for guidance from the MoH, nurses must speak up at a local level, by influencing policy to support and guide nurses on conscientious objection, on having conversations with patients about the assisted dying service, and on how NPs can partake in this service while working to their scope.

Nurses can attend MoH webinars and raise questions with the ministry’s regulatory assurance team responsible for implementing the act by emailing eolc@health.govt.nz. Being part of professional nursing groups and colleges is another platform to have your voice heard. Waiting for others to provide guidance may result in complaints being laid against nurses.

References

  1. Ministry of Health. (2021, May). End of Life Choice Act 2019: Information for Health Professionals (PDF, 159 KB).
  2. Pesut, B. T. (2020). Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study. Global Qualitative Nursing Research, 6-11. doi: 10.1177/2333393620938686