Priorities for End of Life Choice

Opinion: The NZ public gave a 'yes' vote in the end of life choice referendum, but now what? Dr Tanisha Jowsey lists the priorities for a new era in patient care.

Be compassionate to our palliative health nurses and doctors; their work is already anything but easy, says Dr Jowsey. Photo: iStock

The outcome of the end of life referendum – which is binding – marks a massive change in New Zealand’s history. The public have voted, and more than 60 percent of us want options for terminally ill people who are suffering.

Five years ago in New Zealand the late Lecretia Seales, a lawyer, advocated for this decision and today we are seeing the outcome of that hard journey.

Many healthcare professionals have weighed in on both sides of the debate leading up to the referendum. Those against have stated that palliative care already serves patients with compassionate and respectful care. But some using that argument have also acknowledged that palliative care is not always accessible to everyone in New Zealand.

Priorities in the days ahead

Priority One: Steps must be made to ensure the law change protects and supports vulnerable groups – such as Māori and Pasifika peoples, people of low socio-economic status, those who live rurally, the very, very old, people with cognitive decline as a result of their terminal illness, and so forth. "The vulnerability paradox" is where people who don't have good access to specialist palliative care are those same people who will not be able to access this legislation. The law change needs to address this.

Priority Two:
The law change must support health care professionals in their palliative practices. And while we’re at it, we need more funding for palliative services across the board. We all deserve and want quality palliative care when our time comes. We want to feel valued, dignified and supported during our palliative journeys. Better access to quality palliative care will be the answer that many terminally ill people who are suffering actually want. We should continue to complete mental health reviews and follow palliative care pathways.

Priority Three: ensure healthcare curricula changes are made in line with the law to teach our future healthcare workforce how to carefully navigate these waters. While junior doctors and nurses will learn much of the practicalities of end of life care – as they have always done – from their senior colleagues, work will be needed to ensure alignment between their curricula and workplace training.

Priority Four: be kind and compassionate to our palliative health nurses and doctors. They are our frontline people and the work they (already) do is anything but easy. The last thing we want from this vote is for them to be left in deep moral distress. As far as I can tell they all deserve awards for the positive differences they make daily for people in New Zealand.

If we can address these priorities we will be in a stronger position as a nation moving forward. For indeed, we are all in this waka together – to the end of the journey.

Dr Tanisha Jowsey is a senior lecturer at the Centre for Medical and Health Science Education in the Faculty of Medical and Health Sciences.

This article reflects the opinion of the author and not necessarily the views of the University of Auckland.

Used with permission from Newsroom Priorities for End of Life Choice 3 November 2020.

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