Discussion paper
—Maryanne Spurdle | Interrogating Choice
“Offering euthanasia to any patient who doesn’t also have access to a hospice bed or in-home palliative care prioritises utility over compassion.”
Before New Zealand passed the End of Life Choice Act by public referendum in 2019, Maxim Institute researched the experience of euthanasia overseas and the potential risks of the Act. We recommended a “no” vote.
Following the Ministry of Health’s 2024 review of the Act’s implementation, Interrogating Choice examines the quality of end-of-life choices now on offer. Does the system support patient autonomy, or merely the illusion of it?
What’s inside Interrogating Choice
- • Recommendations to strengthen safeguards and oversight
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• The inequities in access to end-of-life care
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• Pitfalls in errors of diagnosis and prognosis
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• The varied faces of coercion
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• Growing threats to freedom of conscience for doctors and care providers
The paper in brief
Since New Zealand’s End of Life Choice Act came into effect in November 2021, euthanasia has been available as a fully funded option for eligible patients. However genuine end-of-life choice remains elusive for many Kiwis. Palliative care is not universally accessible and relies heavily on underfunded hospice services. This creates a postcode lottery where New Zealanders—overwhelmingly rural, Māori, and Pacifica—miss out on support. Gaps in information, under-resourced services, flawed safeguards, and the Ministry of Health prioritising euthanasia over end-of-life care all undermine the promise of autonomy. Meaningful choice requires strong safeguards and accountability, good end-of-life information, universal access to quality palliative care, and better training for healthcare professionals.
Key takeaways
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• Euthanasia is fully funded and universally available, while palliative care is not. Even though 90% of Kiwis will need some of the end-of-life support palliative care offers, many regions have little or no access to specialists.
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• Fewer than 30% of dying New Zealanders receive hospice care each year, and we need twice the number of palliative care specialists currently in hospitals, communities and hospices.
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• Safeguards do not reliably identify coercion and cannot eliminate errors. Terminal prognoses are often innacurate, and even diagnoses are wrong more than 10% of the time.
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• No cooling-off period is required in New Zealand. The shortest reported time from application to death is just two days, and the most common time frame is two weeks. The Ministry of Health’s review of the legislaiton prioritises ease of access over well-informed decision-making.
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• The Ministry proposes changes that would restrict conscientious objection rights for clinicians, and remove them for care facilities. It identifies traditional Māori beliefs among the hurdles to greater acceptance of euthanasia.
Recommendations
- • Improve public awareness of essential end-of-life information
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• Provide universal access to palliative care
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• Prioritise training in palliative care
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• Fortify protections around euthanasia
Read our Op-Ed
Are we euthanising choice?
Is “choice” really on the table at life’s end, or do geography and funding gaps make the decision for us? We explore how New Zealand’s End of Life Choice Act prioritises an easy death over one that is safe, supported, and focused on relieving suffering. Read on to learn why genuine dignity demands better palliative care, stronger safeguards, and real options for every Kiwi—no matter their postcode.
ReadQuick links | Building on our past work
Podcast
On this podcast we take a deep dive into what the text of the End of Life Choice Act would look like when translated into real life, with Maxim Institute euthanasia researcher Danielle van Dalen, and Dr Stephen Child (former Chair of the NZMA from 2015-2017, and currently serving as an elected member of the New Zealand Medical Council).