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ANALYSIS: The preliminary results of the New Zealand referendum on the End of Life Choice Act were conclusive. About 65.2 percent of voters supported the law’s entry into force, while 33.8 percent opposed it.
Although there are still around 480,000 special votes to be counted, the margin is so large that there is no possibility that they will alter the final result. Accordingly, the 2019 End-of-Life Election Act will come into effect on November 6, 2021, one year after the official vote is announced next week.
Ross Giblin / Stuff
David Seymour and Brooke van Velden celebrate the successful outcome of the end-of-life referendum.
It will then be legal to offer assisted death (AD) to terminally ill people who meet the eligibility criteria of the legislation. The delay in the entry into force of the law provides a window of 12 months to implement the necessary arrangements for the AD to take place.
An important issue that has yet to be determined is whether AD services will be specifically funded and, if so, how. The Ministry of Health will have to resolve this over the next year.
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In the meantime, what should happen next? The immediate priorities for the Director General of Health under the legislation are:
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Appoint a Registrar (Assisted Death)
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Establish the New Zealand End of Life Consultation and Support Group (SCENZ)
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Appoint an End of Life Review Committee.
The role of the registrar (assisted death)
The Registrar (assisted death) plays a key role in monitoring and reporting on compliance with the Law. They will also direct any AD complaints to the appropriate agencies.
The law, administered by the Ministry of Health, requires compliance with strict regulatory processes. These must be documented on the prescribed forms sent to the Registrar before the AD can be performed.
The approval and issuance of these prescribed forms corresponds to the Director General of Health.
What will SCENZ do
Curiously, the Law does not prescribe the composition of the SCENZ Group. It simply requires the CEO to appoint members with the knowledge and understanding necessary to carry out their duties.
The group has essentially two roles:
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Determine the standards of care and advise on the medical and legal procedures necessary for the administration of medications for AD
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Provide practical assistance if requested.
The second role is largely administrative and facilitator. SCENZ must select and maintain a list of healthcare professionals who are willing to participate in EA, which includes:
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Physicians willing to act as surrogate physicians in the event that a person’s physician is unwilling to participate in EA due to conscientious objection.
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Medical professionals willing to provide an independent second opinion on a person’s eligibility for EA
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Psychiatrists who wish to provide expert opinions on a person’s ability, in the event that the attending physician or independent physician is not satisfied that the person requesting EA is competent
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Pharmacists willing to dispense the necessary drugs.
Given these functions, the SCENZ group will presumably be comprised of suitably qualified physicians and pharmacists, as well as individuals with knowledge of the relevant law and Maori Tikanga, although its final composition remains to be seen.
Compliance and review
The Director General of Health must also appoint a three-person End of Life Review Committee. This body is tasked with evaluating reports of assisted deaths to determine whether legal requirements are being met. You can refer cases to the Registrar if you are not satisfied.
The law requires that the committee be composed of an ethicist and two health professionals, one of whom must be performing end-of-life care.
Role of medical advice
Since the medical profession will have primary responsibility for providing EA, it is likely that its professional body, the New Zealand Medical Council, will need to begin formulating and consulting on standards of clinical practice for physicians involved in providing or facilitating EA.
While the council publishes generic standards of professional practice, including standards for obtaining informed consent and cultural safety, specific guidelines for AD should be developed.
The standards should incorporate the legal obligations imposed on physicians under the law. These include the prohibition of initiating a conversation about AD with a patient and the legal obligation to inform a patient of their right to a replacement doctor if their doctor objects to AD.
The Medical Council could also provide guidance on clinical practice issues that may arise, including ways to identify coercion or how to handle difficult conversations with patients (such as when they are determined ineligible under the law).
Objection and obligation
Significantly, the law does not require healthcare institutions to provide EE services. Hospice New Zealand has already indicated that it will not provide AD, as it is contrary to its philosophy “neither hasten nor postpone death”.
However, a recent Superior Court decision notes that while institutions may choose not to provide AD, physicians will be required to fulfill their obligations under the Act, including the obligation to provide information to patients.
Although an organization can choose not to provide AD, it can employ doctors who are willing to do so. Arrangements should be made for such professionals to offer AD outside of their own organization. This is an area that will require careful navigation. 
Jeanne Snelling is a professor at the University of Otago School of Law. Andrew Geddis is Professor of Law at the University of Otago.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
