By Thomas Manch.

Assisted dying services for the terminally ill will be “limited” when the End of Life Choice Act comes into force in November, and health officials say legal action over the law is “almost certain”.

Ministry of Health officials have highlighted “complex and sensitive elements” to the End of Life Choice Act and incoming assisted dying regime in a briefing paper to Health Minister Andrew Little, obtained under the Official Information Act.

Among the issues canvassed in the briefing: “uncertainty” over how many people will seek assisted death, terminally ill patients having to travel for services when the law comes into effect, competing pressures in the health system, and a possible need to rewrite parts of the law to resolve “legislative issues”.

The Ministry of Health moved forward on enacting the End of Life Choice Act on Monday, appointing 11 medical experts to a statutory body, Support and Consultation for End of Life in New Zealand (SCENZ), that will manage the incoming assisted dying regime.

Under the law, which the country voted to be passed in a referendum at the 2020 election, SCENZ will develop and oversee the standards for terminally ill patients should receive when they seek an assisted death.

The ministry said in a statement that planning for the November 7 deadline to implement the End of Life Choice Act was “well underway”.

The briefing paper, provided to the health minister by Director-General of Health Dr Ashley Bloomfield in January, showed there remained numerous unresolved questions and risks surround assisted dying services.

The three “key risk factors” identified so far by health officials were: parts of the health sector refusing to be involved in assisted dying, competing resources and pressures in the health system, and inadequate or insufficient engagement with “stakeholders” within the short timeframe to enact the law.

Officials said there remained “uncertainty” over how many people will seek assisted death, and how many health practitioners would be willing to provide the service.

It was expected that terminally ill patients may have to travel across the country to receive assisted dying services on “day one”, or November 7, when the law requires legalised assisted death be available.

“There is not likely to be nationwide access to health practitioners in all regions trained and willing to participate in assisted dying, meaning people may need to travel for services,” the briefing read.

Similarly, it remained uncertain how assisted dying services would be funded, and officials were also yet to decide whether private medical providers could be involved in delivering the services.

A “key question” was whether it should be fully government funded, or a “mixed-model” – how such a mixed-model could work was not detailed.

The legislation, which was a members’ bill, may need to be rewritten “to ensure that the Act functions as intended”, the paper said.

“There has already been interest from other organisations about amending the Act to resolve some legislative issues. We are working through whether this needs to occur.”

Legal action over assisted dying services was considered “almost certain”, due to the “strong views from sections of public in favour and against assisted dying”.

Stuff has sought an interview with Little in recent weeks about the End of Life Choice Act, however he has not been available.

Bloomfield, in the media release regarding SCENZ, said the 11 medical experts appointed “together bring significant clinical and health and disability sector experience”.

“The SCENZ group brings collective experience in the awareness of Te Ao Māori and an understanding of Tikanga Māori; clinical expertise, expertise in ethics and law, and the disability sector; and includes representation of the views of patients, whānau and the community."

Those appointed to the panel included: Dr Caroline Ansley​, a GP; Heather Browning​, an auditor of the disability sector; Dr Gary Cheung​, a specialisted in old age psychiatry; Dr Te Hurinui Karaka-Clarke​, a Te Reo expert at University of Canterbury; Leanne Manson​, an analyst of Māori policy at the nurses’ union; and Dr Jackie Robinson​, a palliative care specialist.